Use of continuous local wound infusion catheters consistently reduces the need for opioids, both as rescue and total dose. (2B)

In patients with INR of greater than 1.5 but less than 3, the increase in risk with progressive INR prolongation remains unknown. We suggest indwelling catheters may be maintained with caution, based on INR and duration of warfarin therapy. (2C)

Neurologic testing of sensory and motor function should be performed routinely during epidural analgesia for patients on warfarin therapy. To facilitate neurologic evaluation, we recommend that the type of analgesic solution be tailored to minimize the degree of sensory and motor blockade. (1C)

For patients undergoing perineuraxial, deep plexus, or deep peripheral block, we recommend that guidelines regarding neuraxial techniques be similarly applied. (1C)

For patients undergoing other plexus or peripheral techniques, we suggest management (performance, catheter maintenance, and catheter removal) based on site compressibility, vascularity, and consequences of bleeding, should it occur. (2C)

Given the limited pharmacologic data on antithrombotic agents in pregnancy and in the absence of a large series of neuraxial techniques in the pregnant population receiving prophylaxis or treatment for VTE, we suggest that the ASRA guidelines be applied to parturients. (2C)

We suggest that neurologic assessment be continued for at least 24 hours folCing catheter removal. (2C)

We can make no definitive recommendation regarding the management to facilitate removal of neuraxial catheters in patients with therapeutic levels of anticoagulation during neuraxial catheter infusion. (2C)

Postoperative pain must be recognized and treated as soon as possible and as best as possible in all patients. (1B)

Emergency general surgery may be associated with more severe postoperative pain; specific attention should be given to this patient group. (2B)