Is peripheral/plexus block safe in the anticoagulated patient?

Unlike neuraxial anesthesia, performing peripheral nerve blocks in the presence of anticoagulation offers a margin of safety. The catastrophic event appears to be bleeding rather than major neurologic injury. In general, superficial limb blocks are not contraindicated in patients receiving anticoagulation. Deeper blocks such as the posterior lumbar plexus block, especially with the use of continuous catheter technique, necessitate a more prudent approach. Careful risk-to-benefit assessment through thorough preoperative evaluation, awareness of perioperative anticoagulation plans, and good knowledge of drug pharmacology should be applied to individual patients.