Excessive alcohol intake can result in neurological complications, with many secondary to nutritional deficiencies.

Chronic alcohol use can lead to alcoholic neuropathy and may result in sensory, motor and autonomic dysfunction.75

Skeletal muscle weakness and atrophy is seen in patients with alcoholic myopathy and may lead to hyperkalemia, myoglobinuria and subsequent kidney dysfunction.76 77

Document preexisting neurological or musculoskeletal abnormalities.

Weigh risks and benefits of regional anesthesia in patients with peripheral neuropathy or if patient cooperation is a concern.

Multimodal analgesia for pain.

Consult acute pain service.

Alcohol and its toxic metabolites, particularly acetaldehyde, can damage the cardiovascular system. It increases the risk of diseases such as coronary heart disease, stroke, hypertension and cardiomyopathy; the dose and pattern of use heavily influences these risks.78

Assess hemodynamic stability in the context of neuraxial anesthesia as it pertains to volume status and cardiac function.

Alterations in coagulation are common in patients with AUD with a risk of both bleeding and thrombosis due to thrombocytopenia, platelet dysfunction, and alterations in procoagulant and anticoagulant factors.79

Obtain complete blood count, coagulation studies, such as prothrombin and INR.

Regional techniques may be contraindicated in patients with coagulopathy.

The immune system, both innate and adaptive, is adversely affected by alcohol consumption, resulting in abnormal function of neutrophils and macrophages. An imbalance in proinflammatory and anti-inflammatory cytokines is thought to be a primary factor in the increased incidence of nosocomial infection and sepsis.80

Strict adhere to anti-infective practice guidelines with invasive lines such as epidural and peripheral catheters.