SUPERIOR TRUNK BLOCK - A 5-Minute "How-To" Guide

The Superior Trunk Block is an excellent alternative to the interscalene block for shoulder/clavicle surgery and pain. Reasons why it is my personal first-line choice are outlined here -    • Advantages of the SUPERIOR TRUNK BLOCK  
*KEY POINTS*
- Look for and avoid suprascapular and transverse cervical arteries.
- Experiment with probe TILT to obtain the clearest view of the superior trunk and its fascial boundaries.
- Aim into the middle scalene muscle, and away from the superior trunk, when piercing the tough deep cervical fascia.
- Minimize needle-nerve contact with gentle needle motion and hydrodissection.
- Complement with a block of the supraclavicular nerves as the needle is withdrawn - this is quick, safe, and easy.

SUPRACLAVICULAR NERVES
- these are the lower branches of the superficial cervical plexus
- they innervate the superficial tissues over the "cape" of the shoulder, but also give off perforating branches to innervate the clavicle and its associated joints - acromioclavicular and sternoclavicular - see https://pubmed.ncbi.nlm.nih.gov/34725...
- they are thus an essential target in shoulder/clavicle surgery and pain, and an important adjunct to a superior trunk/interscalene block.
- it can also be performed for postoperative rescue analgesia if patients have pain localized to the clavicle or AC joint.
- if done as a separate block , a 25G needle can be used as the nerves are so superficial.
- it is an easy block to perform with no side-effects; I prefer it to a superficial cervical plexus block as it spares the upper branches that innervate the jaw and ear.
- if the nerves are not clearly visible, infiltrate 5-10ml of LA at the level of the superior trunk, above the deep cervical fascia over middle scalene muscle.

This video is for informational and educational purposes only. It is not a substitute for professional medical advice, or consultation with a health care professional.