• Jessica F Davies, Scott McAlister, Matthew J Eckelman, Forbes McGain, Richard Seglenieks, Elena N Gutman, Jonathan Groome, Natasha Palipane, Katherine Latoff, Dominic Nielsen, Jodi D Sherman, and TRA2SH, GASP and WAAREN collaborators.
• Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia. Electronic address: jess.davies4@austin.org.au.
• Br J Anaesth. 2024 Dec 1; 133 (6): 143914481439-1448.

BackgroundPharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period.MethodsLife-cycle assessment of GHG emissions (expressed as carbon dioxide equivalents CO2e) of i.v. and oral paracetamol preparations was performed. Perioperative paracetamol prescribing practices and costs for 26 hospitals in USA, UK, and Australia were retrospectively audited. For those surgical patients for whom oral formulations were indicated, CO2e and costs of actual prescribing practices for i.v. or oral doses were compared with optimal oral prescribing.ResultsThe carbon footprint for a 1 g dose was 38 g CO2e (oral tablet), 151 g CO2e (oral liquid), and 310-628 g CO2e (i.v. dependent on type of packaging and administration supplies). Of the eligible USA patients, 37% received paracetamol (67% was i.v.). Of the eligible UK patients, 85% received paracetamol (80% was i.v.). Of the eligible Australian patients, 66% received paracetamol (70% was i.v.). If the emissions mitigation opportunity from substituting oral tablets for i.v. paracetamol is extrapolated to USA, UK, and Australia elective surgical encounters in 2019, ∼5.7 kt CO2e could have been avoided and would save 98.3% of financial costs.ConclusionsIntravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.Copyright © 2024 British Journal of Anaesthesia. All rights reserved.

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