Reducing the Carbon Footprint of Hand Surgery: An Environmental Analysis of the Wide Awake Local Anesthesia No Tourniquet Approach for Pediatric Trigger Thumb Release.

PURPOSE: The health care system accounts for 5% to 10% of national greenhouse gas (GHG) emissions in the USA and Canada. As institutions commit to more sustainable practices, health care professionals must develop methods to reduce the sector's carbon footprint without compromising patient care. For hand surgeons, wide awake local anesthesia no tourniquet (WALANT) has emerged as a potential solution. This study aims to quantify the environmental impact of WALANT compared with general anesthesia (GA) in pediatric hand surgery.

METHODS: A life-cycle assessment was conducted to compare the GHG emissions of 2 standardized approaches for trigger thumb release at a tertiary pediatric hospital: WALANT in an outpatient minor procedure room, and GA in a traditional operating room. Emission sources included surgical supply manufacturing, waste elimination, facility energy consumption, and anesthetic gases. Validated environmental metrics were applied to quantify the GHG emissions associated with each technique.

RESULTS: Wide awake local anesthesia no tourniquet was associated with considerably lower GHG emissions from surgical supply manufacturing (3,133 vs 7,269 g CO2e), waste elimination (211 vs 552 g CO2e), and facility energy consumption (2,988 vs 28,786 g CO2e). The sterilization of surgical instruments yielded 962 g CO2e per case for both techniques. Anesthetic gases contributed an additional 1,707 g CO2e per case performed under GA. Overall, WALANT resulted in an 81% reduction in total GHG emissions per case (7,295 vs 39,276 g CO2e; difference: 31,981 g CO2e).

CONCLUSIONS: Wide awake local anesthesia no tourniquet in an outpatient minor procedure room represents an environmentally responsible alternative for pediatric hand surgery while maintaining favorable clinical outcomes. Thus, efforts are required to expand its application in children. Complementary sustainability strategies must also be implemented to further reduce the carbon footprint of operative care.

CLINICAL RELEVANCE: Adopting resource-conscious approaches such as WALANT can help hand surgeons achieve sustainability goals while preserving the quality of care for pediatric patients.