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Intertruncal approach to the supraclavicular brachial plexus, current controversies and technical update: a daring discourse
  1. Urooj Siddiqui1,
  2. Anahi Perlas1,
  3. Kijinn Chin1,
  4. Miguel A Reina2,
  5. Xavier Sala-Blanch3,4,
  6. Ahtsham Niazi1 and
  7. Vincent Chan1
  1. 1Anesthesia and Pain Management, Toronto Western Hospital, University Health Netwrok, Toronto, Ontario, Canada
  2. 2Department of Anesthesiology, CEU San Pablo University School of Medicine, Madrid, Spain
  3. 3Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  4. 4Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
  1. Correspondence to Dr Anahi Perlas, Anesthesia and Pain Management, Toronto Western Hospital, ON M5T 2S8, Canada; anahi.perlas{at}


We propose a new approach to local anesthetic injection for the supraclavicular brachial plexus block: an intertruncal approach by which local anesthetic is deposited in the two adipose tissue planes between the upper and middle and the middle and lower trunks. We present sonographic and microscopic images to illustrate the relevant anatomy. This approach offers potential advantages over the ‘corner pocket’ technique in that it results in consistent local anesthetic spread to the three plexus trunks and the needle endpoint lies farther away from the pleural surface which is important for the prevention of pneumothorax. It also offers an advantage over the ‘intracluster’ approach as it purposefully avoids intraneural injection respecting the integrity of the epineurium of individual trunks. Comparative studies are required to confirm that these anatomic and technical advantages result in improved outcomes.

  • anatomy
  • brachial plexus
  • upper extremity

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  • Twitter @PerlasAnahi, @AhtshamNiazi

  • Contributors US wrote the first draft of the manuscript and obtained the sonographic images. AP designed the concept of the manuscript, edited the manuscript and the sonographic images. KC edited the manuscript. AN edited the manuscript. MAR provided the microscopic images and edited the manuscript. XS-B edited the manuscript. VC edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.