Sir,Firstly, I appreciate the prompt management of patients, which avoided catastrophe even after the intra-arterial injection of the local anaesthetic solution. However, I have to make a few comments regarding their approach and put forth a few suggestions.It is an accepted fact that the previously suggested paratracheal technique,[1] which authors’ have used, resulted in many serious complications. Therefore, fluoroscopic-guided techniques are standard practice today.During the repeat injection, the authors used fluoroscopy and contrast with a safe and effective outcome. However, their suggestion that fluoroscopy should be used in difficult cases only is not appropriate.We do not know in which patient intra-arterial injection may take place as the negative aspiration test is not foolproof.[23]I feel that the morbidity which occurred due to the “locked-in syndrome” and other serious side-effects that may occur during stellate ganglion block could be avoided if contrast injection and fluoroscopy are used in every patient, irrespective of subjective assessment of easy or difficult case.