Multimodal Analgesia: An Evidence-Based Practice Project for the Management of Postoperative Pain

Abstract

Purpose: The purpose of this quality improvement (QI) project is to increase anesthesia providers' MMA knowledge and willingness to use MMA through a live presentation educational event at Arrowhead Regional Medical Center (ARMC). Background: Prescription opioid misuse causes about 17,000 deaths annually, with over 10 million individuals misusing prescription opioids (CDC, 2019; SAMHSA, 2019). The opioid epidemic forces all healthcare providers to examine their role in this crisis. Anesthesia providers play a significant role in the crisis by introducing their patients to opioids and managing postoperative pain. Poorly managed postoperative pain may lead to acute and chronic pain syndromes (Mills et al., 2019). The introduction of Multimodal Analgesia (MMA) utilizes multiple non-opioid medications targeting various receptors to reduce acute and chronic pain (Brown et al., 2018). MMA effectively manages postoperative pain and reduces opioid requirements (Li & Chen, 2019; Xu et al., 2018). Methods: The design is a pre- and post-survey educational program to assess ARMC anesthesia providers’ MMA knowledge and willingness to use MMA techniques. The PI created an MMA training after a review of the literature. The PI provided anesthesia providers with live MMA training via a PowerPoint presentation, collected demographic data, assessed current MMA knowledge and utilization, and assessed post-training MMA knowledge and willingness to use MMA techniques. Results: Eighteen anesthesia providers attended the MMA presentation, including six certified registered nurse anesthetists (CRNAs) and 12 resident registered nurse anesthetists (RRNAs). There was a statistically significant increase in anesthesia providers’ MMA knowledge, as demonstrated by the increase in post-survey scores following the MMA training. The anesthesia providers also reported being more confident in utilizing MMA and more likely to use MMA in future practice. Conclusions: This project successfully demonstrated that providing anesthesia providers with live MMA education increases their MMA knowledge and willingness to use MMA. However, potential barriers may remain in MMA utilization, such as lack of access to MMA drugs, institution culture against MMA use, and lack of confidence in utilizing MMA.