Ambulatory Regional Anesthesia/Analgesia: A Quality Improvement Initiative

Objective Our objective was to evaluate the impact of a quality improvement (QI) initiative on the regional anesthesia placement-to-infant delivery time during cesarean delivery (CD). Study Design We performed a quality improvement trial. Before June 18, 2018, the preoperative protocol was as follows: the anesthesiologist administered regional anesthesia in the operating room then the nurse placed the Foley's catheter, clipped pubic hair, precleaned the abdomen, and abdominal preparation. On June 18, 2018, the protocol changed and all the preoperative preparation (Foley's clip and preclean) were performed prior to the arrival in the operating room. The records of patients who underwent scheduled or nonemergency CD between May 1 and July 15, 2018, were reviewed. Our primary outcome was time between the placements of regional anesthesia to infant delivery at the time of CD. Bivariate and multivariable analyses were performed. Results A total of 194 patients were included, 124 before and 70 after the process change. The change in process leads to a significant reduction in anesthesia-to-delivery time, even after adjusting for number of prior CD and body mass index (BMI). Other times were also significantly impacted by the change. Conclusion Our QI initiative significantly decreased the time from anesthesia placement to delivery of the fetus. Performing preoperative preparation activities, such as Foley's placement and shaving, after regional anesthesia for CD, increase the risk of fetal exposure to maternal hypotension. We evaluated the impact of a QI initiative on regional anesthesia placement to infant delivery time during CD.

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HOW MANY PAIN PILLS DO WE PRESCRIBE: A SURVEY OF PARTICIPANTS IN SCORE: A QUALITY IMPROVEMENT INITIATIVE (204)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00313 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0031

Author(s):

Kenny Halloran ◽

Henry Ellis ◽

Philip Wilson ◽

Jennifer Beck ◽

Gregory Schmale ◽

...

Keyword(s):

Quality Improvement ◽

Pain Management ◽

Regional Anesthesia ◽

Sports Medicine ◽

Ligament Reconstruction ◽

Knee Arthroscopy ◽

Management Strategies ◽

Invasive Procedure ◽

Quality Improvement Initiative ◽

Pediatric Sports Medicine

Objectives: The public health opioid abuse epidemic has led to nationwide interest in judicious use and close monitoring of opioid pain medication. Knee arthroscopy(KA) and anterior cruciate ligament reconstruction(ACLR) are common procedures in adolescent patients for which narcotics have been historically utilized for post-operative pain management. The purpose of this study is to investigate pain management strategies following basic KA or ACLR by pediatric sports surgeons who contribute to a multi-center quality improvement initiative(SCORE). Methods: Surgeon participants in SCORE represent fifteen U.S. institutions from primarily academic teaching hospitals who specialize in pediatric sports medicine. Surgeons contribute all ACLR and other KA-related cases. A RedCap survey was distributed to all SCORE surgeon participants in December 2019. A KA (defined as a knee arthroscopy that does not include a ligament reconstruction or a cartilage procedure other than chondroplasty) represented a less invasive procedure, while the ACLR represented a more invasive procedure. Survey results were collected and analyzed for both practice patterns of regional anesthesia utilization and post-operative narcotic prescribing volumes. Results: Twenty-eight SCORE surgeon participants completed the survey, a 100% response rate. A planned prescription of a mean of 16.4 pain pills (range 0-40 pills) were reported for pain management following a KA, only 32.1% of surgeons reported adjunctive regional anesthesia techniques for this procedure in addition to general anesthesia. Following an ACLR, surgeons reported a planned prescription of a mean 23.8 pain pills (range 0-40 pills) and most (92.3%) reported utilization of regional anesthesia for their peri-operative analgesia strategy. Of those using adjunctive regional anesthesia, significant variability was reported: 30.7% reported indwelling catheter placement for peripheral nerve block following ACLR as opposed to a single shot injection method, and several block locations were reported to be utilized of which adductor canal (67.9%) block was the most common (see Figure 1). For both procedure types, variability in multi-modal pain management was noted, with incomplete adoption of the use of additional non-narcotic medication (acetaminophen, 64.2%; and NSAIDS, 75%). Cryotherapy devices were applied/prescribed in 75.0% of knee arthroscopy procedures and 92.8% of ACLR. Conclusions: Despite evidence for effective adjunctive pain management strategies, incomplete adoption of multi-modal techniques and reliance on narcotic medication remains a significant component of pediatric sports surgical practice; with on average > 15 pills prescribed following these procedures. Opportunities for reducing practice variability, adoption of multi-modal analgesia strategies, and decreasing post-operative narcotic use following common adolescent knee procedures exist for this subset of pediatric sports medicine specialists

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