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We read with interest a recent article by Luchsinger et al.1 This study investigated a controversial topic related to erector spinae plane block (ESPB). Does local anesthestic block the anterior rami of spinal nerves? Based on cadaveric injections, the authors concluded that ESPBs do not affect the ventral rami of the spinal nerve,and, therefore, should not be referred to as a “paravertebral by proxy” block. However, previous literature on this topic has been divided, with cadaver studies showing mixed results.2 3 We believe that it is important to fully understand the variables that might be influencing these inconsistent outcomes.