Date of Award

Fall 12-2019

Document Type

DNP Project

Project Team Faculty Member

Mary Lee Barron, PhD,

Project Team Faculty Member

Thomas J Smith, DNP, CRNA-APN


ketamine, analgesia, opioid tolerance, postpartum, pain management


The current opioid epidemic demands the development of new management policies and staff education to increase awareness of issues and improve care of patients with Opioid Use Disorder (OUD). A recent dramatic increase in OUD during pregnancy has paralleled the epidemic observed in the general population. The combination of OUD and cesarean delivery, place both the mother with OUD and neonate at risk for increased postoperative complications. The purpose of this project was to evaluate and increase staff knowledge regarding OUD in obstetrics. An analysis of staff knowledge was performed via surveys both pre and post dissemination of evidence. The survey results demonstrated the education positively impacted participant knowledge related to OUD in parturients in addition to ketamine pharmacokinetics and pharmacodynamics. A subsequent policy was developed involving a subanesthetic intravenous (IV) ketamine infusion as part of a multi-modal, low-opioid pain management regimen for the opioid tolerant patient, intraoperatively and post cesarean section. The evidence supports subanesthetic ketamine as an ideal, non-opioid, potent analgesic medication with little to no negative side effects. The evidence has demonstrated low-dose ketamine in conjunction with a multi-modal approach, reduced overall perioperative opioids and pain scores for up to six weeks while maintaining cardiovascular and respiratory stability.

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