Multimodal Analgesic Strategy for the Management of Pain Associated with Burn Injuries

Abstract

Objective: The purpose of this DNP quality improvement (QI) project is to increase anesthesia providers’ multimodal analgesia (MMA) knowledge and access willingness to use MMA to effectively control burn patients’ pain through a live presentation educational event at Valleywise Health Medical Center (VHMC). Background: Pain management is a major challenge in patients with burn injuries. This is because of the complexity of pain associated with burn injury. Pain management is complicated by repetitive procedures to improve patients’ outcomes, such as wound debridement, dressing changes, and skin grafting. Also, desensitization of opioid receptors occurs with chronic use of opioids. Therefore, if acute pain is not adequately controlled, it leads to chronic pain, making pain more challenging to control. Methods: A 30-minute live presentation of a multimodal analgesic strategy for managing pain associated with burn injury was delivered to Valleywise Health Medical Center anesthesia providers, incorporating American Burn Association (ABA) guidelines for managing acute burn pain. Change in knowledge and willingness to change practice was evaluated with a 17-item measure using a pretest and post-test design. Results: Twenty-one anesthesia providers completed both the pre- and post-survey; this includes eight physician anesthesiologists, 11 certified registered nurse anesthetists (CRNAs), and two student registered nurse anesthetists (SRNAs). There was a statistically significant improvement in anesthesia providers’ MMA knowledge, as shown by the increase in post-survey scores following MMA education. Similarly, the anesthesia providers reported being more confident in utilizing MMA, including regional anesthesia, and more likely to use MMA in future burn pain management. Conclusion: This DNP QI project showed that providing anesthesia providers with live MMA education increases their MMA knowledge and willingness to use MMA to effectively control pain associated with burn injuries. However, in MMA utilization, barriers such as the cost of some adjuncts, continuity of MMA in the burn units, lack of confidence in utilizing MMA, availability of some medications, and anesthesia providers’ preference exist.