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Background and Aims Perioperative services are major sources of greenhouse gas (GHG) emissions within hospitals. Inhaled anesthetics used in general anesthesia (GA) are a significant source of GHGs due to their high atmospheric lifetime and potency as climate pollutants. Regional anesthesia (RA) offers a lower-emission alternative when clinically appropriate. While RA is widely used in elective orthopaedic procedures for its clinical advantages and enhanced OR efficiency, it remains underutilized in orthopaedic trauma. We evaluated orthopaedic trauma anesthesia at a Level 1 trauma center, examining the environmental and operational impacts of RA versus GA.Methods This retrospective study analyzed 1,307 orthopaedic trauma surgeries performed between November 2022 and April 2024. Cases were categorized by primary anesthetic technique: RA (neuraxial (NA) and peripheral nerve blocks (PNB)), or GA. The primary outcome was the comparative environmental impact between anesthetic techniques, measured through greenhouse gas (GHG) emissions from inhaled anesthetics. Secondary outcomes evaluated efficiency via perioperative time intervals, post-anesthesia care unit (PACU) requirement and length of stay.Results RA was the primary anesthetic in 23.5% of cases, with GA the primary anesthetic in 76.5%. The GA cohort generated 8,400 kg CO 2 equivalents from inhaled anesthetics, compared to zero in the RA group. Patients receiving PNB had shorter pre-incision times (28.6 minutes) and OR exit times (10.5 minutes) compared to NA (36.6 minutes and 13.2 minutes) and GA (40 minutes and 18.1 minutes). PNB cases bypassed PACU 59% of the time compared to <1% of NA and GA cases. For patients requiring PACU care, PNB cases had the shortest duration (119.2 minutes), followed by GA (168.4 minutes) and NA (186.5 minutes). No significant anesthesia-related adverse events were reported in any group.Conclusions RA eliminated volatile anesthetic emissions while maintaining safety comparable to GA. Broadening RA implementation in orthopaedic trauma presents an opportunity to improve perioperative efficiency and contribute to healthcare sustainability goals.