Minimising Harm beyond the Patient: The Ecological Advantages of Regional Anaesthesia

Locoregional anaesthesia (LRA) offers substantial environmental advantages over general anaesthesia (GA), particularly volatile-based techniques, which are among the largest contributors to perioperative greenhouse gas (GHG) emissions and persistent chemical pollution. All currently used volatile anaesthetics are per- and polyfluoroalkyl substances (PFAS) with exceptionally high near-term atmospheric warming potential and millennia-scale environmental persistence. Nitrous oxide (N2O), typically used at high concentrations, adds a substantial climate and ozone depletion burden. In contrast, LRA eliminates the need for these agents, preventing both their GHG emissions and PFAS release, while enabling GA—if required—to be delivered more sustainably with total intravenous anaesthesia (TIVA). The cradle-to-grave footprint of LRA is typically ~1.5 kg CO2e, compared with 17–442 kg CO2e for volatile-based GA—an order-of-magnitude or greater difference—even when using “low fresh gas flow” techniques. Additional sustainability gains can be achieved through reducing unnecessary disposables, optimising fresh gas flow in TIVA, and improving waste segregation and recycling. This chapter outlines evidence-based strategies to quantify and reduce anaesthesia-related environmental impact without compromising patient safety or clinical outcomes. In addition to its clinical advantages, LRA—combined with sustainable perioperative practices—represents a highly impactful and immediately actionable pathway for mitigating climate change and reducing persistent chemical pollution in anaesthesia.