Journal of special operations medicine : a peer reviewed journal for SOF medical professionals · 2026
Analgesia in Tactical Combat Casualty Care (TCCC): TCCC Guideline Change 25-03.
СтатьяОбзорКлинические рекомендацииНазвание и аннотация: Перевод в очереди
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Barbee George A, Byrne Brendan T, Clayton Cyril E, Cole Jacob H, Conklin Curtis C, Donovan Kellye A, Fisher Andrew D, Gelfand Harold J, Hughey Scott B, Hupfl Kyleigh B, Hutchison Chris W, Keeley Kevin J, King Jacob R, Kumar Alexander J, Lawrence Kendra L, Littlejohn Lanny F, Remley Michael A, Simmons Sean M, Wier Russell P, Wilson Zachary D, Yeager Anthony P, Butler Frank K, Montgomery Harold R, Deaton Travis G
Аннотация
Battlefield pain management (BPM) is a critical and ethical component of TCCC. In 2025, the loss of access to oral trans-mucosal fentanyl citrate (OTFC) and a strategic focus on large-scale combat operations prompted the Committee on Tactical Combat Casualty Care (CoTCCC) to update its analgesia guidelines. The CoTCCC performed an extensive literature review to address key questions regarding OTFC alternatives, ketamine dosing, ethical challenges, and scalability. The review identified buprenorphine and intranasal esketamine as viable alternatives to OTFC, based on their pharmacology, efficacy, and safety. The updated TCCC guidelines propose a simpli-fied, two-step model: Step 1 recommends a non-opioid pill pack for mission-capable casualties, including a novel sodium channel inhibitor, suzetrigine; and Step 2 advises a fixed dose of ketamine (or esketamine) via intramuscular, intranasal, or slow intravenous/intraosseous push alongside the pill pack for non-mission-capable casualties. This framework reduces provider cognitive burden, simplifies logistics, and enhances battlefield analgesia. Recommendations are rated from level of evidence A to C-EO and Class I to IIa, highlighting future research needs.