Efficacy of Intertruncal Vs classical approach of Supraclavicular brachial plexus block for upper extremity surgery : a double blinded randomised controlled trial

Supraclavicular block once described as the “spinal anaesthesia of the arm” because of greater safety due to real time ultrasound guidance and better block dynamics.1 The supraclavicular approach to the brachial plexus characteristically associated with the rapid onset of anaesthesia and has high success rate.1-2 Supraclavicular block offers dense anaesthesia of the brachial plexus for surgical procedures at or distal to the elbow.3-8 There are various ways of providing brachial plexus block through supraclavicular approach which includes multiple injection spanning from 6’o clock position, 12’o clock position of supraclavicular artery. This approach is called as classical approach, this provides excellent block characteristics. However, intraneural injections can be devastating complication in this approach which can result in permanent injury to brachial plexus. To prevent this complication double injection technique - known as intertruncal approach (IA) which  aims to provide satisfying block dynamics of the entire brachial plexus while avoiding intraneural injection, in which local anaesthetic (LA) is accurately deposited to adipose tissue planes between the upper and middle , middle and lower trunks. However it’s a new procedure with varying results reported  in few of the studies conducted. The purpose of  this study is to compare the onset time efficacy in Intertruncal Vs Classical approach of supraclavicular brachial plexus block.