• Brandi Tinsbloom, Virginia C Muckler, William T Stoeckel, Robert L Whitehurst, and Brett Morgan.
• Brandi Tinsbloom, DNP, CRNA, is a graduate of the Duke University Nurse Anesthesia Program. She is a practicing CRNA at a regional medical center in Pinehurst, NC. She has interests in community hospitals and outpatient and office-based practices. Virginia C. Muckler, DNP, CRNA, CHSE, is Assistant Professor in the Duke University Nurse Anesthesia Program in Durham, NC. She serves as a reviewer for multiple journals, is a National League for Nursing Simulation Leader, has served as a simulation consultant nationally and internationally, and serves on national and state associations. William T. Stoeckel, MD, is the owner of Wake Plastic Surgery in Cary, NC. He completed his plastic surgery training at Wake Forest University in 2002 and has been in his solo private practice since. He specializes in body and breast outpatient plastic surgery procedures using MAC anesthesia. Robert L. Whitehurst, MSN, CRNA, is founder and President of Advanced Anesthesia Solutions. He received his BSN from East Carolina University and his MSN (Anesthesia) from Duke University. Robert has practiced as a CRNA in academic institutions, community hospitals, and outpatient and office-based practices since 2004. Robert is an advocate for patients and CRNA practice as Chair of NCANA PAC and his work to expand the availability of anesthesia services to underserved settings. Brett Morgan, DNP, CRNA, is Assistant Professor at the Duke University School of Nursing and the Director of the Nurse Anesthesia Specialty Program. In addition to his faculty role, Dr. Morgan practices clinical anesthesia in office-based settings throughout the research triangle.
• Plast Surg Nurs. 2017 Oct 1; 37 (4): 137-143.

AbstractMany patients undergoing plastic surgery experience significant pain postoperatively. The use of preemptive, multimodal analgesia techniques to reduce postoperative pain has been widely described in the literature. This quality improvement project evaluated the implementation of a preemptive, multimodal analgesia protocol in an office-based plastic surgery facility to decrease postoperative pain, decrease postoperative opioid consumption, decrease postanesthesia care time, and increase patient satisfaction. The project included adult patients undergoing surgical procedures at an outpatient plastic and cosmetic surgery office, and the protocol consisted of oral acetaminophen 1,000 mg and gabapentin 1,200 mg. Using a pre-/postintervention design, data were collected from patient medical records and telephone interviews of patients receiving the standard preoperative analgesia regimen (preintervention group: n = 24) and the evidence-based preemptive, multimodal analgesia protocol (postintervention group: n = 23). Results indicated no significant differences between the pre- and postintervention groups for any of the outcomes measured. However, results showed that patients in both groups experienced moderate to severe pain postoperatively. In addition, adverse side effects such as dizziness and drowsiness were higher in the postintervention group than in the preintervention group. Although this quality improvement project did not meet the goals it set out to achieve for patients undergoing plastic surgery, it did illustrate the substantial presence of pain after surgical procedures. Thus, clinicians need to continue to focus on identifying targeted treatment plans that use multimodal, non-opioid-based strategies to manage and prevent postoperative pain.

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