There is growing evidence for the benefits of regional anaesthesia (RA) and calls have been made to ensure its accessibility to all patients.^1,2 In high-income countries, there is often political pressure to centralise specialised services, targeting increased patient volume, greater clinical expertise and more specialised facilities. ADDIN EN.CITE Bhattarai2016885In this context of centralised services, it may not always be beneficial, necessary or possible to provide RA training to all. For the purposes of this debate, these concepts will be further explored.

Risk vs benefit There are certain patient populations in whom RA undoubtedly has a morbidity and mortality benefit, for example that of spinal anaesthesia in the obstetric population.⁴ It would therefore be difficult to argue against the position that every anaesthesiologist should be proficient in this technique.

In contrast, enthusiasm for thoracic epidurals has been waning over recent years.