Propofol Target-Controlled Infusion with the Eleveld Model in Opioid-Sparing and Opioid-Free Anaesthesia: A Narrative Review

Background/Objectives: The Eleveld pharmacokinetic–pharmacodynamic (PK-PD) model is among the most extensively validated general-purpose models for propofol target-controlled infusion (TCI). It includes a binary covariate for concomitant drug administration, commonly labelled as opioid use, which reduces elimination clearance (CL) and the volume of the second peripheral compartment (V3) in an age-dependent manner. This works well for conventional opioid-based anaesthesia but is less clear for multimodal, opioid-sparing regimens built around ketamine, magnesium sulfate, dexmedetomidine and intravenous lidocaine. This review discusses how these four non-opioid adjuvants may interact with Eleveld-based propofol TCI dosing.

Methods

We conducted a structured, non-systematic literature search of PubMed/MEDLINE, the Cochrane Library and the MDPI full-text index between May and early August 2026, combining terms for the Eleveld model and propofol TCI with terms for each adjuvant and for pharmacodynamic endpoints (EC50, Ce50, bispectral index, propofol requirement). Studies without a propofol-specific endpoint were excluded from the adjuvant-effect analysis.