To Örebro University

Background: Primary total hip arthroplasty and total knee arthroplasty are common surgical procedures that require effective perioperative care to ensure early mobilisation, reduced complications, and shortened hospital stay. Effect-site target-controlled infusion (TCI) combined with SmartPilot View (SPV) is a novel approach to total intravenous anaesthesia that may improve anaesthetic precision and reduce postoperative side effects. However, it has not been thoroughly evaluated in joint arthroplasty. The aim of this study was to evaluate the early anaesthetic outcomes in hip and knee arthroplasty patients following the implementation of effect-site TCI and SPV.

Methods: We conducted a retrospective cohort study including 2316 procedures (2210 patients) at & Ouml;rebro University Hospital, Lindesberg, Sweden, between 2018 and 2023. Two groups were compared: pre-implementation (2018-2019, n = 1258) using plasma-targeted TCI without SPV, and post-implementation (2022-2023, n = 1058) using effect-site TCI with SPV. Patients from 2020 to 2021 were excluded due to the COVID-19 pandemic and the overlap of methods during implementation. Data were extracted from the Swedish Perioperative Register. The primary outcome was the incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included length of stay in the post-anaesthesia care unit (phase II), postoperative pain, and surgical duration.

Results: PONV incidence decreased significantly from 8.4% to 3.0% after implementation (p < 0.001; adjusted OR: 0.36, 95% CI: 0.23-0.55). Median post-anaesthesia care unit stay decreased by 70 min (95% CI: 61-78 min; p < 0.001). Postoperative pain scores were slightly lower in the post-implementation group (median numeric rating scale 7 vs. 5; p < 0.001). Surgical duration increased marginally (84 vs. 87 min; p = 0.003).

Conclusions: Implementation of effect-site TCI and SPV in hip and knee arthroplasty was associated with significantly reduced PONV and shorter post-anaesthesia care unit stay, suggesting improved early postoperative recovery.

Clinical trial number: Not applicable.