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Background: Stellate ganglion block is used for the diagnosis and treatment of sympathetically maintained pain syndromes. Multiple anatomic variations and inaccurate sympathetic block may mislead the diagnosis and prevent patients from receiving potentially beneficial interventions. We describe a novel approach to blockade of the sympathetic chain at C7 and at T2 to T3 with a single-needle injection., Technique: With the patient in supine position, the uncinate process of C7 is identified fluoroscopically as a target for insertion of a catheter through a Touhy needle. The catheter is directed caudally to the junction of T2 and T3. Contrast injection confirms the spread to the appropriate levels before injection of local anesthetic., Conclusion: This novel approach to blockade of the upper extremity sympathetic innervation may enhance diagnostic accuracy and therapeutic benefit as compared with traditional approaches to the stellate ganglion alone. This approach may be expected to decrease the risk of pneumothorax when compared with the posterior approach to T2 to T3.