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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

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Recycling Implementation in Wide-Awake Local Anesthesia No Tourniquet Hand Surgery.

Miles C Farlow1, Bayli Price1, Victoria Robinson1

  • 1Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics and Neurosciences, Roanoke, VA.

The Journal of Hand Surgery
|June 2, 2026
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Summary

Implementing recycling in wide-awake local anesthesia no tourniquet (WALANT) hand surgery reduced waste by 16%. This initiative offers significant waste reduction potential for high-volume surgical settings.

Keywords:
Hand surgeryWALANTrecyclingsurgical wastewaste reduction

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Area of Science:

  • Surgical waste management
  • Environmental impact of healthcare
  • Sustainable surgery

Background:

  • Wide-awake local anesthesia no tourniquet (WALANT) surgery is associated with lower waste and carbon emissions compared to traditional operating room procedures.
  • The increasing adoption and high volume of WALANT procedures make them a prime target for waste reduction strategies.

Purpose of the Study:

  • To quantify waste reduction achieved through recycling implementation in a WALANT procedure room.
  • To identify the primary materials contributing to waste in WALANT procedures.

Main Methods:

  • A prospective study involving waste measurement before and after a recycling intervention in a single institution's WALANT procedure room.
  • Baseline waste generation was assessed for 33 procedures, followed by a 4-day period where recyclable materials were separated and weighed.
  • Analysis included waste per case and identification of recyclable/nonrecyclable items in a standard WALANT carpal tunnel release kit.

Main Results:

  • Preintervention, WALANT procedures generated an average of 3.30 lbs (1.50 kg) of waste per case.
  • Postintervention, recycling diverted 0.49 lbs (0.22 kg) of waste per case, representing 16% of the total waste stream.
  • Nonrecycled waste decreased by 0.80 lbs (0.36 kg) per case, with surgical drapes and sterile solution bottles being major contributors to remaining nonrecyclable waste.

Conclusions:

  • Recycling implementation in WALANT procedure rooms can divert approximately 16% of total waste.
  • The intervention required minimal workflow changes and demonstrated significant procedural waste reduction, particularly in high-volume settings.
  • These findings underscore the need for continuous innovation in surgical material management to enhance sustainability.