Date of Award

Spring 5-6-2022

Document Type

DNP Project

Project Team Faculty Member

Project Team Faculty Member

Dr. Joseph Grazaitis


Neuraxial anesthesia, spinal anesthesia, total joint arthroplasty, total knee replacement, postoperative pain, best practice guidelines, ERAS protocols


This quality improvement doctoral nursing project sought to provide a sustainable and data-driven change process at a critical access hospital in Illinois. The main objective of this project was an improvement in postoperative pain scores and implementation of best practice guidelines regarding total joint arthroplasty. Total joint arthroplasty is one of the most common surgical procedures performed in the United States. Future figures predict exponential growth due to our aging patient population, the obesity epidemic, and continued improvements in technique. Despite advances, orthopedic surgeries continue to be taxing on the body and can produce significant complications. General anesthesia for these procedures has been associated with increased postoperative complications, including enhanced risk for deep vein thrombosis, blood loss, and postoperative nausea and vomiting. In direct comparison, neuraxial anesthesia has demonstrated superior outcomes, including reduced blood loss, DVT and PONV risk, as well as a reduced need for postoperative opioid consumption due to enhanced pain control. As such, neuraxial anesthesia has become regarded as the superior anesthetic technique for total joint arthroplasty, in addition to the utilization of local infiltration anesthesia and peripheral nerve blockade. An initial retrospective chart review was conducted to identify anesthetic modality and most notably postoperative pain scores for total joint arthroplasties conducted at the institution. Following the review, a change process towards utilization of neuraxial anesthesia as the main anesthetic modality for total joint arthroplasty where eligible was stressed. A prospective chart review was then conducted to compare and contrast the obtained data. Final statistically analyzed data was then presented in PowerPoint form to all available anesthesia and surgical staff. A completion survey was conducted to validate the efficacy of the change process. Principally, this project demonstrated superior results concerning reduced postoperative pain scores when neuraxial anesthesia was provided for total joint arthroplasty procedures. Despite barriers to the implementation of this project, both the survey results and the chart review figures demonstrated the relevance and applicability of continuing this process change at the facility at hand.

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Abstract & Keywords

Included in

Nursing Commons



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