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still lacks data, this topic should be explored more deeply. Our 5. De Buck F, Devroe S, Missant C, Van de Velde M. Regional an-
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still employed in developing countries, is an avenue that the thesiol Clin Pharmacol. 2015;31(3):384–393. doi:10.4103/
SOF medical community could exploit (e.g., intravenous re- 0970-9185.161679
gional anesthesia). With a 0.04% maximum reported inci- 7. Albrecht E, Bloc S, Moret V, Cadas H. Manuel pratique d’anes-
dence of long-term complication, diffusion blocks, such as the thésie locorégionale échoguidée. Elsevier Masson; 2014.
WALANT technique, are very low risk and can be used by 8. Terrados JJ. Hybrid warfare. The Three Swords Magazine. De-
SOF medical providers to manage pain in isolated environ- cember 2019. Accessed March 3, 2023. https://www.jwc.nato.int/
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ments. However, it is always advisable to calculate the precise 9. de Leon JD. Understanding multi-domain operations in NATO.
toxic dose of local anesthetic, based on the patient’s weight. The Three Swords Magazine. October 2021. Accessed March
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The addition of epinephrine at a concentration of 1:200,000 10. Chen YK, Boden KA, Schreiber KL. The role of regional anaesthe-
can be useful for long-term pain management. Moreover, in sia and multimodal analgesia in the prevention of chronic post-
operative pain: a narrative review. Anaesthesia. 2021;76 Suppl
the case of intravenous injection of the local anesthetic, epi- 1(Suppl 1):8–17. doi:10.1111/anae.15256
nephrine will warn the provider through mild tachycardia and 11 Schulz-Stübner S. Regional analgesia in the critically ill patient.
an increase in blood pressure of this complication. However NYSORA. Accessed February 17, 2023. https://www.nysora.com/
iterative negative aspiration remains the safest way to execute topics/sub-specialties/comorbidities/regional-analgesia
the injection to avoid intravascular injection. To conclude, lo- -critically-ill/
co-regional anesthesia is a useful alternative to regional anes- 12. Buckenmaier C III, Bleckner, L. Military Advanced Regional An-
esthesia and Analgesia Handbook. The Henry M. Jackson Foun-
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with close monitoring. 14. Annex B/C: NSOCM/NSOMT In: Critical task list NSHQ-MED
Directive 75-001. NATO; 2017.
Acknowledgments 15. Video AAR of the Jan 2016 Marjah Firefight and PFC MEDEVAC.
Special thanks to my unit, the Special Forces Group, which Prolonged Field Care Collective. Accessed Jan 27, 2024. Video
AAR of the Jan 2016 Marjah Firefight and PFC MEDEVAC –
always pushes me forward, as well as to our medical advisor ProlongedFieldCare.org
who supported this work. My gratitude to all the military an- 16. NATO Special Operations Forces (SOF) Medical Support –
esthesiologists who give me guidance and valuable comments, AMEDP-4.13. NATO; 2021.
including OF-4 Dr. François, OF-4 Dr. Pregler, OF-2 Dr. Jemni, 17. Jones MR, Novitch MB, Hall OM, et al. Fascia iliaca block,
and OF-1 Dr. Henry. history, technique, and efficacy in clinical practice. Best Pract
Res Clin Anaesthesiol. 2019;33(4):407–413. doi:10.1016/j.bpa.
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Thank you to the whole ISTC Medical Branch Staff for shar- 18. O’Reilly N, Desmet M, Kearns R. Fascia iliaca compartment block.
ing their expansive knowledge, especially OF-3 Broussard for BJA Educ. 2019;19(6):191–197. doi:10.1016/j.bjae.2019.03.001
his experience in “dirty” medicine. 19. Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake local anesthe-
sia with no tourniquet: an updated review. Plast Reconstr Surg Glob
Disclosures Open. 2021;9(3):e3507. doi:10.1097/GOX.0000000000003507
The authors have no conflict of interests to disclose. 20. Vloka J, Van Keer L. Cutaneous nerve blocks of the lower ex-
tremity. NYSORA. Accessed July 2, 2023.https://www.nysora.
com/techniques/lower-extremity/saphenous/cutaneous-nerve-
Funding blocks-lower-extremity/
No funding was received for this work. 21. Gitman M, Fettiplace M, Weinberg G. Local anesthetic systemic
toxicity. NYSORA. Accessed February 24, 2023. https://www.
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