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The Environmental Impact of Wide Awake Local Anesthesia No Tourniquet (WALANT) versus Systemic Anesthesia in Pediatric Trigger Thumb Release
Aidan Shulkin, MD, Daniel E. Borsuk, OQ, MD, MBA, FRCSC, FACS; Emilie Bougie, MD, MHPE, FRCSC
Centre hospitalier universitaire Sainte-Justine, Montreal, QC, Canada
Introduction: The healthcare sector accounts for approximately 5% of worldwide greenhouse gas emissions. Operating rooms are particularly resource-intensive, consuming substantial energy and producing a significant share of hospital waste. This study evaluates the environmental impact of performing pediatric trigger thumb release using a Wide Awake Local Anesthesia No Tourniquet (WALANT) approach compared to systemic anesthesia, with the aim of informing more sustainable surgical practices without compromising patient care.
Materials & Methods: A retrospective review was conducted of all trigger thumb releases (i.e., open A1 pulley release, tenosynovectomy) performed by a single surgeon at a tertiary pediatric health center over a five-year period. Patient records and institutional data were extracted to perform a life-cycle assessment comparing the carbon emissions of two surgical approaches: WALANT, executed in an outpatient minor procedure room, and systemic anesthesia (i.e., sedation, general anesthesia), executed in a traditional operating room. Emission sources included disposable surgical supply manufacturing, waste elimination, facility energy consumption, and anesthesia. Standardized environmental metrics were applied to quantify and compare the emissions associated with each approach.
Results: Fifty-six patients underwent trigger thumb release: 39 using WALANT and 17 under systemic anesthesia. No complications occurred, and all patients achieved satisfactory functional outcomes at final follow-up. The WALANT approach was associated with significantly lower carbon emissions from disposable surgical supply manufacturing (3.72 vs. 7.36 kg CO?e), waste elimination (0.22 vs. 0.52 kg CO?e), and facility energy consumption (2.98 vs. 25.28 kg CO?e). The sterilization of reusable surgical instruments yielded 0.94 kg CO?e per case in both groups. Volatile anesthetic gases contributed an additional 1.71 kg CO?e per case performed under systemic anesthesia. Overall, the WALANT technique resulted in a 78.06% reduction in total carbon emissions per case compared to systemic anesthesia (7.86 kg vs. 35.81 kg CO?e; difference: ?27.95 kg CO?e).
Conclusion:Performing pediatric trigger thumb release using the WALANT approach significantly reduces carbon emissions compared to systemic anesthesia, without jeopardizing functional outcomes or patient safety. These findings support the integration of this technique into pediatric hand surgery, aligning with institutional efforts to reduce healthcare's environmental footprint without compromising patient care.
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