Regional anaesthesia in combat settings: a position paper from military physicians

Regional anaesthesia (RA) is a powerful tool in combat casualty care. As contemporary warfare evolves towards major engagements and delayed evacuations, the need for effective, durable and logistically feasible pain management has become critical. RA offers significant clinical and tactical advantages by providing sustained analgesia without impairing consciousness. Despite this, its use remains largely restricted to anaesthetists due to training gaps and institutional inertia. This position paper supports the integration of RA into the standard combat medical toolkit and the training of non-specialist military physicians in its use. Drawing on data from recent military studies and field experience, we explore the benefits of RA in austere settings, the current barriers to its widespread adoption, and the required steps to institutionalise its practice-including doctrinal changes, structured training and strategic support tools such as telemedicine and artificial intelligence. Implementing this position could contribute to improving pain control on the battlefield and preserving operational capacity.