Anesthesia and Analgesia Methods in Primary Total Hip Arthroplasty and Primary Total Knee Arthroplasty-A Survey of Nordic Anesthesiologists.

Background: The objective of this survey was to assess the current practices of analgesia and anesthesia for patients undergoing primary hip (THA) and knee (TKA) total joint arthroplasty in the Nordic countries. Additionally, we aimed to explore the differences in anesthesia and analgesia techniques, prevalence of day case surgery procedures, criteria for patient selection, and the challenges associated with patient discharge.

Methods: An online survey was created and distributed to all anesthesiologists of Nordic orthopedic surgical units conducting over 100 arthroplasties a year according to national arthroplasty registries.

Results: Out of 298 survey responses, 94.3% reported following a standard operation procedure (SOP). Preoperative medication was used by 65.1% for THA and 63.1% for TKA patients. Intraoperative corticosteroids were administered by 79.2% for THA and 81.7% for TKA patients. Spinal anesthesia was used for THA (95.6%) and TKA (92.3%), with bupivacaine preferred for spinal anesthesia in THA (83.9%) and TKA (88.4%). Local infiltration analgesia (LIA) was used for 37.6% of THA and 64.4% of TKA patients. Peripheral nerve blocks were administered by 8.1% for THA and 40.9% for TKA patients. Postoperative pain medications included opioids (96.0%), paracetamol (93.0%), NSAIDs including COX-2 inhibitors (81.9%), and gabapentinoids (8.4%). Antiemetics were used by 43.7%. Nearly half of respondents (49.7%) from 61 hospitals reported performing primary THA and TKA as day-case procedures, but less than 25% of patients had day surgery. Delayed discharge reasons included intense pain, motor weakness, and postoperative nausea and vomiting (PONV).

Conclusions: There is general agreement in the Nordic countries on preoperative medication, anesthesia techniques, and multimodal pain management, though variability exists in the use of peripheral nerve blocks and LIA. Day-case TJAs are common, especially in Denmark. Pain, motor weakness, and PONV are the main barriers to same-day discharge. The survey suggests that better management of PONV with consistent use of antiemetics could improve recovery and reduce discharge delays. This report describes survey results about anesthesia management preferences for anesthesia management for adult hip and knee arthroplasty cases in Nordic countries. The findings demonstrate practice focus on early recovery where possible.