Evaluating Anesthesia Providers' Willingness to Adopt Erector Spinae Block for Cesarean Section

Abstract

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI) project is to enhance anesthesia providers’ knowledge of bilateral Erector Spinae Plane Block (ESPB) and assess their readiness to incorporate it into postoperative pain management for cesarean sections. The initiative aims to educate providers on the effectiveness of ESPBs as an opioid-sparing, multimodal strategy, ultimately improving patient outcomes and reducing opioid use. Background: Cesarean sections, performed over a million times annually in the United States (US), are often accompanied by significant postoperative pain. Current opioid use poses risks, including sedation and breastfeeding complications. ESPBs offer a promising alternative to reduce opioid consumption and improve pain relief, minimizing risks to maternal-neonatal bonding. ESPBs can also be utilized as a rescue block for severe or uncontrolled post-cesarean pain. This project targets anesthesia providers to improve their knowledge and adoption of ESPB for optimized pain management. Methods: This QI project utilized a descriptive and comparative quantitative design to evaluate an educational intervention for anesthesia providers. The intervention consisted of an evidence-based presentation followed by pre- and post-surveys. The surveys assessed current pain management practices, familiarity with ESPB, and barriers to adoption. Data analysis using the Wilcoxon Signed-Rank Test measured changes in knowledge and willingness to use ESPB. The project followed the Plan-Do-Study-Act (PDSA) cycle for continuous improvement. Results: Sixteen providers attended, and 14 completed the post-surveys, yielding a 87.5% response rate. Demographics included 43% physician anesthesiologists, 43% CRNAs, 7% RRNAs, and 7% medical students. Survey results showed that 64% of providers used intrathecal morphine “most of the time,” and 50% used facial plane blocks “sometimes.” Post-survey analysis showed significant improvements in knowledge, confidence, and willingness to adopt ESPB (z=2.541, p=0.0111; z=3.050, p=0.0023; z=3.177, p=0.0015). Conclusions: This project demonstrates that an educational intervention effectively enhances anesthesia providers’ knowledge and willingness to adopt ESPB for post-cesarean pain management. While immediate goals were achieved, further research with larger populations is needed to assess long-term impacts. Sustainable strategies, including ongoing workshops, interprofessional collaboration, and institutional integration, are essential for continued adoption of ESPB in clinical practice.