Environmental responsibility in resource utilization during the practice of regional anesthesia : a Canadian Anesthesiologists’ Society Delphi consensus study

Ip, V.H.Y. and Shelton, C.L. and McGain, F. and Eusuf, D. and Kelleher, D.C. and Li, G. and Macfarlane, A.J.R. and Raft, J. and Schroeder, K.M. and Volk, T. and Sondekoppam, R.V. (2025) Environmental responsibility in resource utilization during the practice of regional anesthesia : a Canadian Anesthesiologists’ Society Delphi consensus study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 72 (3). pp. 436-447. ISSN 0832-610X

Abstract

Purpose: Regional anesthesia (RA) is often perceived to be more environmentally sustainable than alternative forms of anesthesia. Nevertheless, the principles of sustainable RA remain ill-defined in the presence of variability of resource utilization within RA practice. Many infection prevention practices are based on low-level evidence, and recommendations vary internationally. We sought to conduct an evidence review and Delphi consensus study to provide guidance on aspects that lack high-quality evidence in RA practice to reconcile responsible resource stewardship and infection prevention in RA. Methods: We conducted a three-round modified Delphi process. After distributing an initial free-text questionnaire to all collaborators, we created structured questions, followed by two rounds of anonymized voting. We defined strong consensus as ≥ 75% agreement and weak consensus as ≥ 50% but < 75% agreement. Results: Forty-six experts agreed to take part in the study and 36 (78%) completed all the voting rounds. Regional anesthesia practice parameters with strong consensus included hand hygiene using alcohol scrub rather than soap and water, sterile gowns being unnecessary for single-injection RA techniques, only minimal equipment in the premade packs, and goal-directed use of sedation and supplemental oxygen. Discussion: We obtained consensus on the safe and environmentally responsible practice of RA for both single-injection and indwelling catheter techniques and identified areas of research focus. While more robust evidence is being generated, clinicians may use these findings as a guide to infection prevention and environmental sustainability in their anesthesia practice. © Canadian Anesthesiologists' Society 2025.