LAUSR

I commend Adhikary et al. [1], Womack et al. [2] and ElBoghdadly and Wiles [3] for increasing the collection and interpretation of further evidence supporting the use of novel chest wall blocks for analgesia after rib fracture. El-Boghdadly and Wiles not only assert that ‘thoracic epidural analgesia should no longer be considered a firstline regional anaesthetic technique in these patients’ but also that this is the only analgesic modality with demonstrable effects on pain, pulmonary complications andmortality. Given that the range of chest wall blocks detailed require varying degrees of specialist skills which may not be available in all centres, at all times, particularly out-of-hours, do El-Boghdadly and Wiles accept that thoracic epidural analgesia (TEA) should remain a skill taught to and practised by all anaesthetists? I am concerned that any recommendations abandoning TEA may lead to some anaesthetists avoiding analgesia administration rather than attempt a unilateral technique with which they are not familiar, worsening outcomes for the patient. T. Heinink Frimley Park Hospital, Frimley, UK Email: [email protected]