O'Sullivan and Lavelle raise several issues regarding our multicentre trial [1] that are worth addressing. They express concerns about the control group, citing the Serious Harm and Morbidity scale on placebo-placed blocks. We did consider alternatives such as an assessor-blinded study design, but we believe that many extremely optimistic and positive assessor-blinded studies on fascial plane blocks may be influenced by some form of bias. Double-blind trials remain the strongest form of scientific testing, and we presented a thorough case for this when seeking approval from our institutional review board (IRB). Before commencing the trial, I met with Prof Dr Jens Børglum at Zealand University Hospital in Roskilde to ensure an impeccable placement technique with minimal risk [2].

Although details of IRB approval were edited out after peer review, the link to the initial protocol published in trials, containing all specifics of the IRB review, is provided in the text and easily accessible [3]. In our opinion, non-steroidal anti-inflammatory drugs (NSAIDs) are essential in any multimodal pain regimen after colorectal surgery [3]. Many pain studies are not accepted for publication without an adequate institutional pain protocol. If any of the fascial plane blocks were truly effective, they should be able to make a difference even in combination with multimodal analgesics. In fact, well-established regional anaesthesia techniques, such as thoracic epidural analgesia, remain highly effective even when combined with NSAIDs [4].

The authors rightly point out the dosing of local anaesthetics. In fact, we failed to detail an essential part of our methodology. Patients weighing < 60 kg received only 20 ml of ropivacaine 0.375%. However, over 95% of all patients exceeded that weight and received 30 ml of this concentration. This means that patients < 75 kg received a slightly higher dose than the appointed 3 mg.kg^-1. Nevertheless, we felt confident, as our previous research on lateral quadratus lumborum blocks and plasma levels of ropivacaine with the same fixed dosing, demonstrated acceptable plasma levels [5].

Finally, we did not include local anaesthetic port infiltration after surgery, unlike Tanggaard et al., who bilaterally infiltrated 30 ml ropivacaine 0.375% [6]. Although the weight range of their included patients was smaller (61.4–99.4 kg), we believe this might pose an even greater risk within a 4-hour time window.

To conclude, it is crucial to recognise that all fascial plane blocks necessitate sufficient volume to successfully exert an effect. In the context of minimally invasive surgery and robust multimodal analgesia, a block that adds no additional benefit poses more of a liability than a contribution to good patient care.

O'Sullivan 和 Lavelle 提出了有关我们的多中心试验 [ 1 ] 的几个值得解决的问题。他们对对照组表示担忧，并引用了安慰剂组的严重危害和发病率量表。我们确实考虑过诸如评估者盲法研究设计之类的替代方案，但我们认为，许多对筋膜平面块极其乐观和积极的评估者盲法研究可能会受到某种形式的偏见的影响。双盲试验仍然是最有力的科学测试形式，在寻求机构审查委员会 (IRB) 的批准时，我们为此提供了详尽的案例。在开始试验之前，我会见了罗斯基勒西兰大学医院的 Jens Børglum 教授，以确保以最小的风险实现无可挑剔的放置技术 [ 2 ]。

尽管 IRB 批准的详细信息在同行评审后被删除，但文本中提供了试验中发布的初始方案的链接，其中包含 IRB 评审的所有细节，并且易于访问 [ 3 ]。我们认为，非甾体抗炎药 (NSAID) 在结直肠手术后的任何多模式疼痛治疗方案中都是必不可少的 [ 3 ]。如果没有适当的机构疼痛方案，许多疼痛研究不会被接受发表。如果任何筋膜平面阻滞确实有效，那么即使与多模式镇痛药结合使用，它们也应该能够发挥作用。事实上，成熟的区域麻醉技术，例如胸段硬膜外镇痛，即使与非甾体抗炎药联合使用仍然非常有效[ 4 ]。

作者正确地指出了局部麻醉药的剂量。事实上，我们未能详细说明我们方法论的一个重要部分。体重 < 60 kg 的患者仅接受 20 ml 0.375% 罗哌卡因。然而，超过 95% 的患者超过了该体重并接受了 30 毫升该浓度的治疗。这意味着<75 kg的患者接受的剂量略高于指定的3 mg.kg ^-1。尽管如此，我们仍然充满信心，因为我们之前对侧腰方肌阻滞和相同固定剂量罗哌卡因血浆水平的研究表明血浆水平可接受[ 5 ]。

最后，我们没有包括术后局部麻醉端口浸润，这与 Tanggaard 等人双侧浸润 30 ml 0.375% 罗哌卡因不同 [ 6 ]。尽管纳入的患者体重范围较小（61.4-99.4 公斤），但我们相信这可能会在 4 小时的时间窗口内带来更大的风险。

总而言之，重要的是要认识到所有筋膜平面块都需要足够的体积才能成功发挥作用。在微创手术和强大的多模式镇痛的背景下，不增加额外益处的阻滞更多地带来了负担，而不是对良好患者护理的贡献。