Doctor of Nursing Practice (DNP) Projects

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Post-BSN for Nurse Anesthetists (DNP-NA)


breast surgery, mastectomy, enhanced recovery after surgery, opioid, narcotic, pain


Patients undergoing breast surgery are at risk of developing persistent post-operative pain and prolonged opioid use. Most patients who receive breast surgery do not have chronic pain pre-operatively, but up to 60 percent will experience chronic pain post-operatively. AtlantiCare Medical Center made opioid minimization a top priority in the institution and has openly adopted Enhanced Recovery After Surgery (ERAS) protocols for other surgical specialties. After performing a systematic literature review, an ERAS protocol for breast surgery patients was developed for use in a quality improvement project. Patients selected included those undergoing unilateral or bilateral mastectomy and/or, staged reconstruction surgery. The protocol was implemented via an electronic application utilized by the Anesthesia Department for ERAS anesthesia techniques. Key aspects of the protocol were broken down into pre-operative, intra-operative and post-operative aspects. Preoperatively, Acetaminophen and Gabapentin were administered. Intraoperatively, pectoralis blocks were performed by anesthesia, administration of long-acting opioids were minimized, and adequate prevention of post-operative nausea and vomiting (PONV) were utilized. Post-operatively, patients were encouraged early oral intake and reduced use of opioid for pain control. Total morphine milliequivalents (MMEs) during anesthesia care were analyzed pre- and post-protocol implementation via deidentified medication administration reports. Patients of similar American Society of Anesthesiologists (ASA) status, weight and surgical procedure were compared to provide consistent analysis between pre-intervention and post-intervention groups.


Data collection was completed by the above authors along with Dr. Mark Schmidheiser, of Atlanticare Health System. Data analysis was completed by the authors. The data reported in this article will be presented via a virtual poster presentation due to the concurrent COVID-19 pandemic, at the annual University of Pennsylvania Doctor of Nursing Practice presentation. The authors have no conflicts of interest to disclose and no funding was received.

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Date Posted: 25 February 2022