Episode
PFC Podcast 277: Multimodal Analgesia - Making Your Limited Narcotics Last Longer in Prolonged Field Care
- Podcast
- Prolonged Field Care Podcast
- Published
- May 4, 2026
- Duration seconds
- 2698
- Processing state
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Summary
In this must-listen episode, Dennis sits down with Dr. Jon Andrews—former 5th and 20th Group Special Forces medic turned Duke-trained anesthesiologist (pediatric & cardiac fellowships)—to tackle one of the biggest headaches in austere medicine: you have a tiny box of opioids and ketamine, a long mission, and a patient who needs to stay alive AND comfortable. They break down exactly how to stretch every milligram using real OR strategies adapted for prolonged field care: patient-specific planning, smart titration, multimodal synergy, regional blocks, ketamine myths, and when (and how) to layer non-narcotics without crashing your patient or your supply. Why this episode matters: Acute pain becomes chronic pain. Chronic pain leads to opioid dependence, PTSD, and worse outcomes. In the field, your choices today shape your patient’s tomorrow—and whether you still have meds left when the next casualty shows up. Key Takeaways Start low, titrate smart. Cut your first dose in half on sick or unstable patients. You can always give more—never the other way around. Multimodal is mission-critical. Hit pain from every angle (blocks + ketamine + acetaminophen + judicious NSAIDs) to dramatically reduce opioid requirements and prevent chronic pain pathways. Ketamine IS an analgesic. It’s not just dissociation—it’s an NMDA antagonist that blunts central sensitization and has proven opioid-sparing effects. Schedule your non-opioids. Acetaminophen (1 g IV/PO/PR q6h) and longer-acting adjuncts form your baseline; use fentanyl or morphine only for breakthrough. Blocks beat everything—if you can do them. Pre-emptive regional anesthesia (when feasible) is the single highest-yield move before surgical stimulus hits. Monitor like your life depends on it. Heart rate, blood pressure, and resp…