Enhanced Recovery After Surgery (ERAS) Pathway for Primary Hip and Knee Arthroplasty

"ERAS pathway for orthopedic surgeons:~1. Shortened preoperative fasting from intake.~2. Preoperative tranexamic acid administration.~3. No indwelling catheters.~4. No tourniquet used for TKA.~5. No drainage tube.~6. Application of the low molecular heparin 6 hours after the operation.~ERAS pathway for anesthesiologist:~1. Intravenous 20 mg of dexamethasone before anesthetic induction.~2. Anesthesia will be induced with small dose of long-acting opioids such as sulfentanil, or without long-acting opioids at all.~3. Laryngeal mask for airway.~4. Anesthesia will be maintained with short-acting anesthetic agents such as desflurane, sevoflurane, or propofol, with continuous remifentanil , and BIS value will be kept between 40 to 60 during procedure.~5. Incision infiltration with 40-50ml of 0.2% ropivacaine, and no patient controlled intravenous analgesia devices will be applied."

Patients undergoing THA or TKA will receive conventional care according to different participating center, and there's no standard protocol for pre-operative management, anesthetic technique or medication choice, postoperative analgesia or food intake, or catheters indwelling.