Damage Control Surgery is provided at Role 2. An anesthesiologist and/or certified registered nurse anesthetist who will be on staff and in conjunction with the surgeons, will be responsible for perioperative pain management. Role 2s differ in the capability with some consisting of a single operating room bed and a single post-operative ICU bed while others have attached Emergency Care and Post-Operative Holding Capacity.

In the more austere Role 2, pain should be managed with intravenous opioids and ketamine titrated as needed to provide adequate pain control; if dysphoric symptoms emerge with ketamine, then a small amount of benzodiazepine should be administered.

More robust Role 2s will have additional personnel, equipment, and supplies available. At these locations, the capability might exist for peripheral nerve blocks, which could be performed by the anesthesia provider or by the orthopedic surgeon assigned to the unit. Infusion pumps may also be available for continuous opioid infusions in critically injured patients, with dosage titrated as needed to provide adequate pain control. Patients on infusions require close monitoring in an ICU setting. Some of these more robust Role 2s with attached ward holding may have Patient Controlled Analgesia (PCA) pumps that can be used by patients to manage their pain. Pain should be adequately controlled prior to starting PCA; the patient can then use the PCA for self-dosing as needed for pain. The starting doses for PCAs are as follows:

- Morphine PCA in adults is 1-3 mg with 10–20-minute lockout.
- Hydromophone PCA in adults is 0.1-0.3 mg with 10–20-minute lockout.
- Fentanyl PCA is 15-25 mcg with 10–20-minute lockout.

Patients on PCA require monitoring by nursing staff. Naloxone must be available to treat respiratory distress that may occur secondary to opioids.