J Spec Oper Med. 2022 May 31;22(2):154-165. doi: 10.55460/8CBI-GAOD.
Analgesia in the military prehospital setting is one of the most essential elements of caring for casualties wounded in combat. The goals of casualty care is to expedite the delivery of life-saving interventions, preserve tactical conditions, and prevent morbidity and mortality. The Tactical Combat Casualty Care (TCCC) Triple Option Analgesia guideline provided a simplified approach to analgesia in the prehospital combat setting using the options of combat medication pack, oral transmucosal fentanyl, or ketamine. This review will address the following issues related to analgesia on the battlefield: 1. The development of additional pain management strategies. 2. Recommended changes to dosing strategies of medications such as ketamine. 3. Recognition of the tiers within TCCC and guidelines for higher-level providers to use a wider range of analgesia and sedation techniques. 4. An option for sedation in casualties that require procedures. This review also acknowledges the next step of care: Prolonged Casualty Care (PCC). Specific questions addressed in this update include: 1) What additional analgesic options are appropriate for combat casualties? 2) What is the optimal dose of ketamine? 3) What sedation regimen is appropriate for combat casualties?
战地医疗中的镇痛是救治战场上伤员的最重要环节之一。伤员救治的目标是加快实施救生干预，保持战术条件，并预防发病率和死亡率。战术战斗伤员救治（TCCC）三重选择镇痛指南提供了一种在战场预治疗环境中简化镇痛的方法，使用的选择有战斗用药包、口服粘膜芬太尼或氯胺酮。本综述将涉及有关战场上镇痛的以下问题：1. 开发更多的疼痛管理策略。2. 推荐改变氯胺酮等药物的剂量策略。3. 认识 TCCC 中的层次，并为高级提供者制定使用更广泛的镇痛和镇静技术的准则。4. 为需要手术的伤员提供镇静的选择。本综述还承认下一步的治疗：长期伤员护理（PCC）。本次更新中具体涉及的问题包括：1） 哪些额外的镇痛选择适合战斗伤员？2） 氯胺酮的最佳剂量是多少？3） 适合战斗伤员的镇静方案是什么？
