Anesthesiology NewsNew Anesthesia Protocol Shows Strong Outcomes in Hip and Knee Replacement

The SOLIS protocol, a multimodal, opioid-free spinal anesthesia approach, achieved zero conversions to general anesthesia across 906 hip and knee arthroplasties, with only 1.3% of patients failing to ambulate on the day of surgery. Mean postoperative pain scores remained below 2 on the VAS, and average 24-hour morphine equivalent use was 5.0 mg, three to ten times lower than published ERAS benchmarks.

Clinical Considerations

• SOLIS combines short-acting spinal chloroprocaine, opioid- and benzodiazepine-free anesthesia, large-dose local infiltration, and propofol sedation as a unified protocol
• Only 18% of patients required opioids in the PACU, with more than half needing only oral doses
• Complication rates were low: urinary retention 0.9%, orthostatic hypotension 4.6%, DVT 0.2%, PE 0.1%
• Motor block resolved in approximately 70 minutes, enabling early ambulation and likely contributing to the low VTE rate

Practice Applications

• Evaluate SOLIS as a complete protocol, not a menu of individual interventions
• Counsel surgical teams that all components must be combined to replicate published outcomes
• Identify institutional barriers to implementation, including coordinated arthroplasty team requirements
• Consider aspirin-based chemical prophylaxis paired with early mobilization for VTE prevention

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