Intraoperative Esmolol Administration in Managing Postoperative Pain

Abstract

Background: Managing perioperative pain is an essential goal for all anesthesia providers. The utilization of multimodal methods for analgesia is common. Administration of opioids has traditionally been the primary method to control pain. However, opioids have additional side effects such as nausea, vomiting, respiratory depression and potential for long term misuse, all of which can lead to adverse patient outcomes. Research studies suggest perioperative administration of esmolol, a beta-blocker normally used to control heart rate and blood pressure, can decrease opioid requirements. The purpose of this quality improvement study was to assess anesthesia provider’s knowledge of using esmolol for the purpose as an alternative or adjunct to perioperative opioid administration. Methods: A non-experimental descriptive quantitative methodology was employed to evaluate knowledge of esmolol as a perioperative pain management method. A convenience sample of four anesthesia providers working in the main operating suite at a 530-bed acute care facility in a southern Texas town participated in this DNP project. Collection and analysis of data was accomplished through use of a pre and post educational intervention survey. A pre and post survey was used to identify provider knowledge and influence on practice after an education intervention. The pre and post surveys contained the same nine questions, two of which were open ended, to assess achieved learning and/or changes in practice. Results: A total of four anesthesia providers completed the pre survey, educational PowerPoint and post survey. Upon completion of both surveys, the data gathered was entered into SPSS for analysis using a Wilcoxan Signed Rank Test for comparison. No significant changes indicating enhanced knowledge of esmolol use for perioperative pain management was noted post educational PowerPoint. Commonalities regarding patient characteristics and barriers to esmolol use, such as cost and access were reported in the open-ended question. Conclusion: Results suggest anesthesia providers are knowledgeable about use of esmolol as a perioperative pain management method. Barriers surrounding the use of esmolol, such as cost, ease of access and assessment of pain, exist, limiting its use in pain management. Future educational opportunities to increase provider participation and response may provide additional insight to selection and incorporation of different pain management modalities.