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Opioid analgesia on the battlefield: a retrospective review of data from Operation HERRICK
  1. Pip Lewis1,2,
  2. C Wright1,2 and
  3. C Hooper3
  1. 1 Emergency Department, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 1700 Naval Air Squadron, RNAS Culdrose, Cornwall, UK
  1. Correspondence to Pip Lewis, Emergency Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK; pip.lewis1{at}


Background Acute pain secondary to trauma is commonly encountered on the battlefield. The use of morphine to manage pain during combat has been well established since the 19th century. Despite this, there is relatively little research on analgesia use in this environment. This study aims to review the use and complications of morphine and other opioids during Operation HERRICK.

Methods A database search of the Joint Theatre Trauma Registry was completed looking for all incidences of morphine, fentanyl or naloxone use from February 2007 to September 2014. Microsoft Excel was used to analyse the results.

Results Opioid analgesia was administered to 5801 casualties. Morphine was administered 6742 times to 3808 patients. Fentanyl was administered 9672 times to 4318 patients. Naloxone was used 18 times on 14 patients, giving a complication rate of 0.24%. Opioid doses prior to naloxone administration range from 0 to 72 mg of morphine and from 0 to 100 mcg of fentanyl. Four casualties (two local civilians and two coalition forces) received naloxone despite no recorded opioids being administered. Opium abuse was prevalent among the local population in Afghanistan, and this could explain the rationale behind two local national casualties receiving naloxone without any documented opioids being given.

Conclusion The use of opioids in a battlefield environment is extremely safe. Complication rates are similar to previously published data which is reassuring. The efficacy of different opioids was not covered by this study, and further analysis is required, particularly following the introduction of oral transmucosal fentanyl citrate and the availability of novel non-opioid analgesics.

  • pain management
  • military
  • analgesia
  • opioids
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  • Contributors The study was conceived by CW. Literature searches were carried out by PL. Data analysis and interpretation was carried out by PL and CH. The first draft was written by PL and subsequent revisions were made by PL and CW.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data for this article were accessed from the Joint Theatre Trauma Registry (JTTR-UK), which is a database of all trauma patients treated by the Defence Medical Services in Iraq and Afghanistan. Access is necessarily restricted as it contains both confidential medical details and military operationally sensitive information, therefore permission would need to be sought in order to access the original data.

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