Anesthesia and Pain Management in Conflict-Affected Regions: A Narrative Review of Barriers and Strategies for Improving Surgical Care

Background/Objectives: Safe anesthesia and effective pain management in conflict-affected regions are limited by violence, damaged infrastructure, disrupted supply chains, medication and equipment shortages, and loss of trained personnel. This narrative review examines major barriers to perioperative care and practical strategies that may improve access and safety. Methods: A structured literature search evaluated peer-reviewed studies, global health reports, and humanitarian publications, primarily from January 2015 through September 2025, with older foundational clinical sources included when directly relevant to specific anesthesia techniques. Results: Major barriers included shortages of essential anesthetic medications and trained providers, damaged healthcare infrastructure, limited monitoring and oxygen availability, and disrupted supply chains. Reported strategies included ketamine-based anesthesia, regional anesthesia, portable oxygen and anesthesia technologies, telemedicine, and task-sharing models supported by training and local health-system capacity. Obstetric, neonatal, and pediatric patients may face additional risks when appropriately sized equipment, blood products, monitoring, and specialist support are limited. Conclusions: Improving anesthesia and pain management in conflict settings requires adaptable clinical strategies, workforce training, reliable access to essential medications and equipment, and partnerships that strengthen local capacity. Evidence remains heterogeneous, and more conflict-specific outcome data are needed.