I agree with Pandit et al. that putting an additional mark on a patient presenting for elective surgery, who already has a surgical site mark, is unlikely to improve safety and could even lead to wrong-site surgery 1. However, I think that there are certain circumstances in which marking the block site should be encouraged, particularly if nerve catheters are inserted, and invite the authors to comment on the role of ‘anaesthetic’ block site marking in these. Some trauma patients, for example, require a block but are unlikely to require subsequent surgery, such as those presenting with fractured ribs, for whom paravertebral catheters may be inserted. In these cases, ‘anaesthetic’ marking of the block site is mandatory to comply with the ‘stop before you block’ process, involving verification of the site of any pain, the radiological findings or report and emergency department or parent team documentation. Secondly, some trauma patients may require a block before surgical site marking has occurred for subsequent surgery, such as those presenting with fractured neck of femur, for whom fascia iliaca catheters may be inserted. Again, ‘anaesthetic’ marking of the block site may be required. Finally, surgical drapes may cover any surgical marks during nerve block catheter insertion 2, necessitating further ‘anaesthetic’ marking of the block site to reduce the risk of wrong-site block.
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