Paravertebral Blocks in the Adult Thoracic Surgical Patient Enhancing Knowledge for the Anesthesia Provider

ABSTRACT Background: Thoracic Epidural Analgesia (TEA) is currently the gold standard analgesia in adult thoracic surgical patients. TEA has medical complications like sepsis, neurological injury, spinal hematoma, and dural puncture. TEA is also contraindicated for patients with existing neurological or hematological comorbidities including patients under antiplatelet or anticoagulation therapy. These factors not only reduce the scope of administering TEA but also increase the risks of hemodynamic instability like hypotension and bradycardia. PVB can decrease medical complications, side effects, and increase patient satisfaction. Aim: This quality improvement project aims to compare if PVB is more effective than TEA in terms of patient satisfaction, hemodynamic stability, and usage of opiates for pain management after thoracic surgery in adult patients. Results: The study was done using 15 journal articles across a range of time to collect evidence from practice to inform clinical research and decisions on PVB usage. The results showed that PVB was more useful than TEA in managing pain. PVB improved the utilization and effectiveness of opiates, reduced side effects, improved hemodynamic stability, and supported better satisfaction amongst patients than TEA administration. Discussion: The quality improvement project concluded that PVB has less risk of complications than TEA. PVB has certain risks of complications due to an incorrect or erroneous injection method and lack of knowledge of the anesthesia provider administering the PVB. Combining PVB with fentanyl can improve the duration of analgesia and experience of pain. Conclusion: PVB is safer for patients undergoing thoracic surgery than patients undergoing TEA and pain is equally or more efficacious in the management of pai

A Quality Improvement Checklist for the Perioperative Management of Surgical Patients with Opioid Addiction on Buprenorphine

Background: Buprenorphine is a semisynthetic opioid agonist-antagonist that displays antagonism at kappa receptors and partial agonist at mu receptors. Buprenorphine has the unfortunate effect of interfering with the actions of opioids administered for medical indications. When patients on buprenorphine present for surgery or procedures requiring anesthesia, it can become a substantial challenge. Currently, there are no guidelines or checklists that would help the anesthetist to provide adequate pain management for the OUD patient population. Objectives: (1) Understand the perioperative management of patients with opioid addiction on buprenorphine. (2) Demonstrate increased knowledge and confidence in understanding the challenges, pharmacokinetics, and pharmacodynamics of managing a patient on buprenorphine. (3) Discuss and manage perioperative interventions of patients taking buprenorphine with opioid addiction. Methodology: The primary methodology of the proposed project was to administer an online Zoom educational module to providers that focus on the perioperative management of patients with OUD who take buprenorphine. The project was implemented by conducting an online pre-assessment test, zoom educational module, and a post-assessment test that assessed the anesthesia providers\u27 knowledge about managing a patient with OUD on buprenorphine during the perioperative period. Pre-assessment and post-assessment testing were used to measure the effects of the educational module. Statistical analysis was applied to assess the effectiveness of the educational module. Results: There was a total of five Certified Registered Nurse Anesthetists (CRNAs) that participated in the quality improvement project. The results reflected an improvement in knowledge based on the pre-test and post-test scores. Knowledge showed an average gain of (25%). In addition, the post-test demonstrated that participants are most likely (n=4, 80%) or somewhat likely (n=2, 20%) to implement a perioperative checklist for surgical patients with opioid addiction taking buprenorphine. Conclusion: An evidence-based educational module determined an increase in participants\u27 knowledge of managing surgical patients with OUD taking buprenorphine during the perioperative period. There is no consensus on the management of buprenorphine; however, the recommendation is to continue buprenorphine during the perioperative period