Background: With an opioid epidemic encompassing the nation for the past two decades, the U.S. now consumes approximately 80% of the world’s supply of opioids. Opioids are powerful pain medications that have significant side effects. Opioid alternative administration can treat analgesia and limit opioid administration.
Objectives: The purpose of this study was to examine and describe CRNAs’ beliefs, opinions, and practices on administering opioid medications versus opioid alternative strategies to treat intraoperative pain.
Method: A qualitative, survey study design using semi-structured interviews was conducted. Twelve CRNAs were interviewed and audio recorded discussing their perspectives and opinions on administering opioid alternatives. The primary investigator (PI) and committee determined the study eligibility criteria for study participants based on the following inclusion and exclusion criteria:
Inclusion: CRNA with three years of current working experience
Exclusion: Student registered nurse anesthetist (SRNA) and CRNAs with less than 3 years of work experience. The interview questions created were used as a guide and focused on a CRNA’s work experience, experience with ERAS protocols, and experience with opioid alternative pain strategies. The audio recordings were transcribed word for word using Rev professional transcription company and secondary verified by a committee member. The audio recordings were transcribed, they were coded by the primary investigator and two committee members using NVivo transcribing software and double-checked for accuracy.
Results: Two themes were established: barriers and promoting factors with each theme containing sub themes. The subthemes under barriers included: opioid superiority (83%), inconsistent analgesia effects of opioid alternatives (83%), limited experience with opioid alternatives (58%), limited opioid alternative resources (42%), negative experiences with alternative administration (66%), and patient comorbidities (100%). Subthemes under promoting factors included: avoiding adverse effects of opioids (92%), institutional policies (50%), positive experiences with alternative administration (100%), and regional superiority (100%).
Conclusion: Understanding the barriers and promoting factors to opioid alternative administration can be useful to enhance its usage. Larger studies and/or surveys are needed to assess greater sample sizes to further validate the current data.
Keywords: anesthesia, opioids, perceptions, barriers, multimodal strategies, nurse anesthetist, providers
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