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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Orthostatic intolerance (OI) was identified as the primary reason for failed same-day discharge after total hip arthroplasty (THA) at Ziekenhuis Oost-Limburg. Postoperative syncope poses a significant risk for falls and also impedes early mobilization after surgery. This retrospective quality analysis report assesses the effect of routine administration of intramuscular (IM) ephedrine on the occurrence of syncope after THA.Methods A retrospective cohort study was conducted at the ZOL hospital in Genk. Patients following the fast-track hip arthroplasty protocol between May 2023 and April 2025 were assessed for syncope. The incidence of in-hospital syncope on the day of the surgery and syncope on the day after the surgery was compared between patients who did not receive ephedrine and those who received 50 mg IM ephedrine at the end of the surgical procedure. Statistics were performed using R version 4.2.1.Results In total, 273 patients followed the fast-track hip arthroplasty protocol. Follow-up data on 119 patients was available and analyzed. Forty-four patients did not receive IM ephedrine at the end of the surgery, whereas 75 patients did. In-hospital syncope occurred in 2.7% of the patients in the IM ephedrine group and 9.1% in the non-ephedrine group (p=0.19). Syncope on the day after the surgery was present in 3.7% in the ephedrine group and 4.6% in the non-ephedrine group (p=0.15).Conclusions Syncope is common after fast-track hip surgery. The standard use of IM ephedrine in our cohort resulted in less syncope on the day of the surgery, while no differences in incidence were apparent on the day after the surgery. Despite not being significant, the use of IM ephedrine could potentially benefit patients in the prevention of syncope in the hospital.