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Additional surgical site marks: a reply

We thank Dr Buckley for supporting our position [1]. Where the block is the sole intervention, as in the situation Dr Buckley describes, the procedure should be undertaken as if for a ‘surgical intervention’. Thus, there should be a WHO timeout, including check of radiology and consent, equipment/swab/suture/needle count at start and end, and a site mark. There is therefore no ‘anaesthetic mark’ but a single ‘sitemark’. Where surgery is to be performed much later, it is important that the initial site mark is removed at the end of the procedure, just as it should be after surgery and we hope that the reasons for this are selfevident. We are uncertain of the situation Dr Buckley refers to in the context of nerve block catheters. We imagine the scenario proposed is one where the operating surgeon is inserting the catheter peri-operatively? If so, then this is simply part of the surgical procedure and needs no additionalmarking (i.e. recurrentmarking is not required for every suture, incision or step of the surgical procedure). Even if sited by an anaesthetist peri-operatively then de facto, the anaesthetist becomes part of the operative team and again for the same reason, as stated above, no additionalmark is needed. Regardless, in every case, there has to be a ‘stop’ moment just before injection, and there are now suggested several ways to achieve this [2–5]. More widely, a recent report by the Health Service Investigations Branch has asked the Royal College of Anaesthetists and the Safe Anaesthesia Liaison Group to consider updating the specific guidance around Stop Before You Block [6].