Improving Knowledge on Liposomal Bupivacaine and Multimodal Analgesia In Shoulder Surgery

Abstract

Purpose: The purpose of this quality improvement (QI) project is to evaluate the impact of the education provided to anesthesia providers on the use of liposomal bupivacaine (LBC) (Exparel) and best practices in pain management for patients undergoing shoulder surgery at a small hospital in Tempe, Arizona. This project’s overall goal was to improve anesthesia provider knowledge through an educational seminar. Background: Despite improving multimodal analgesia techniques, severe pain and high rates of opioid consumption following shoulder surgery persists. The interscalene block (ISB) continues to be the gold standard for management after shoulder surgery. Liposomal bupivacaine (Exparel) is novel bupivacaine that produces postoperative anesthetic effects equal to the standard bupivacaine ISB, with a prolonged duration. Methods: This DNP project was designed as a QI project aiming to enrich provider knowledge. The Model for Improvement (MFI) framework was utilized to enhance the implementation of this QI project. To disseminate this project, an in-person educational seminar was held for anesthesia providers. Of the 14 providers invited, seven providers attended. Post-pre-survey questionnaires were employed to gather self-reported data. These data were collected, analyzed, and appraised to determine their effectiveness. Results: Of the seven study participants, only four completed the survey in its entirety. Of respondents, 67% cared for patients undergoing shoulder surgery at least 6 to 10 times in the previous 90 days. And 40% of post-pre-survey questions were found to have a statistically significant change in the level of pre- to post-intervention knowledge. Specifically, a significant change in the level of understanding for indications for the use of LBC and safe use within the ISB was noted. Additionally, all (100%) respondents agreed they would consider changing their future practice, following this QI. Conclusion: The goal of this QI project was to improve provider knowledge for patients undergoing shoulder surgery. Based on an individualized needs assessment, an educational QI intervention was developed for anesthesia providers. Overall, results gathered from the survey showed a positive interest in the utility of LBC within ISB and the potential for further implementation, dissemination, and sustainability of this QI project within this local facility.