Battlefield regional anesthesia: Evolution and future concepts

Owing to advanced protective technologies, many servicemembers are returning home with injuries that proved fatal in previous conflicts. However, such severe injuries provide numerous challenges for acute pain physicians. Advanced regional anesthetic techniques provide an essential multimodal tool that optimizes pain and minimizes opioid use. Utilization of such techniques in current conflicts has progressed from a rare occurrence owing to limited equipment and personnel to a widely use array of techniques utilized on the battlefield and continued throughout transport stateside. Such an evolution has enhanced the development of acute pain medicine services within the military that deliver such techniques along with noninterventional techniques. Further, such acute pain medicine services are well received in a combat theater and may serve as an optimal model in future conflicts. Preliminary experience within the last decade has described the interplay of such techniques with anticoagulation regimens in such trauma patients, incidence of infection, levels of serum local anesthetics in patients with multiple catheters, and the utility of such techniques in patients who may be at risk for compartment syndrome but must bear with a long transport chain back home. Looking forward, future training of personnel and tracking of outcomes are essential in optimizing the utility of such techniques in forward environments, but the collection of accurate outcome data will also determine if prolonged benefits can be realized in addition to the obvious benefit downrange.