I read the editorial Regional Anaesthesia and pain relief after surgery by Fredrickson et al1 with interest. The current enthusiasm for ultrasound-guided nerve blocks needs to be tempered by a realisation of the cost of this procedure to the health system or health insurers. In orthopaedics this procedure adds at least 15-30 minutes to the anaesthetic time which translates to an increase in theatre cost, and then a significant increase in rehabilitation time because the knee or hip doesnt work properly and patients mobilisation is delayed. In the hospitals in which I work if these techniques are used one can be sure the patient will require at least one extra day in hospital and often two, the cost of which is borne by the DHB or the health insurer. What benefits are there for the patient? None that I can see given that last year's pain control worked fine, and of course lying around in bed may increase the risk of DVT/PE. Like everything in medicine this current enthusiasm for regional blocks will wain. If you work in the finance department you will be praying it ends soon. Geoffrey Horne Orthopaedic Surgeon Wellington Regional Hospital Wellington