Impact of a nurse anesthetist student–led training program on perioperative pain management in total knee replacement: A prospective before and after study

What is already known • Perioperative pain assessment and management are essential to quality surgical care after total knee replacement. • Nursing documentation of pain remains inconsistent despite existing guidelines. • Evidence on the impact of nurse-led educational interventions on documented perioperative pain practices is limited. What this paper adds • A brief nurse anesthetist student-led training program improved pain assessment traceability and analgesic practices after total knee replacement. • Improvements were greatest in the orthopedic ward, while effects in the operating room and post-anesthesia care unit were limited by documentation systems. • Nurse anesthetist students can effectively contribute to perioperative quality improvement initiatives. : Effective perioperative pain management is essential for patients undergoing total knee replacement. This study assessed professional practices related to perioperative pain evaluation and management at a French university hospital and evaluated the impact of a training program led by nurse anesthetist students. : We conducted a prospective, single-center, observational before-after study (convenience sampling) from September 2022 to May 2023 at Clermont-Ferrand university hospital, France. Data were collected from paper medical records and a structured questionnaire administered to paramedical professionals. Pain assessment practices (traceability of numerical rating scale scores) and analgesic management were evaluated across four phases: two practice-assessment phases separated by a two-step training program. : Data from 51 and 85 patient medical records before the training (Phase 1) and 85 after the training (Phase 4) were analyzed. A total of 74% of operating room staff and 58% of orthopedic-ward staff completed the questionnaire used to develop the training program. Numerical rating scale traceability on orthopedic-ward admission improved from 29.6% to 48.2% (P = 0.03). Documentation of pain at post-anesthesia care unit discharge remained stable (78.4% vs. 82.2%; P = 0.61). Morphine administration and subsequent pain reassessment in the post-anesthesia care unit increased after training. Patient satisfaction with pain management remained high in both periods (90% vs. 80%). : The nurse anesthetist student–led training program improved several aspects of perioperative pain evaluation and management in total knee replacement patients, particularly documentation and analgesic practices. These results highlight the value of involving nurse anesthetist students in quality-improvement initiatives and identify remaining gaps for future targeted interventions.