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Application for ESRA Abstract Prizes:Background and Aims Vertebral Body Tethering(VBT) is an emerging surgical technique for the treatment of adolescent idiopathic scoliosis(AIS). Adequate perioperative analgesia is essential to facilitate early mobilization and minimize opioid consumption. Erector Spinae Plane Block(ESPB) is a novel regional anesthesia technique that has shown promising results in spine surgeries.Methods We report the case of a 12-year-old female with AIS who underwent VBT surgery with perioperative analgesia supported by bilateral ESPB. Following standard monitoring and induction of general anesthesia, the patient was positioned prone. Bilateral ESP blocks were performed at the L2 level under ultrasound guidance using the out-of-plane technique, with 10 mL of 0.25% bupivacaine administered on each side. The surgical technique involved the insertion of a single screw at T12, double screws at each level from L1 to L3, and a single screw at L4 to facilitate anterior VBT. The operation lasted approximately 2 hours, with stable intraoperative hemodynamics.Results The postoperative course was uneventful and demonstrated effective analgesia. Pain was well controlled, with VAS scores of 2/10 at rest and 3/10 with movement during the first 24 hours. Opioid use was minimal; only a weak opioid (tramadol) was required as rescue analgesia, totaling a morphine equivalent dose of 3 mg. The patient ambulated on postoperative day one without significant pain.Abstract P323 Figure 1Ultrasound image demonstrating an erector spinae plane (ESP) block at the L2 vertebral level using the out-of-plane techniqueAbstract P323 Figure 2Anteroposterior (AP) radiographic view of the lumbar spine following scoliosis correction with vertebral body tetheringConclusions Bilateral ESPB may serve as an effective component of multimodal analgesia for patients undergoing VBT for AIS, contributing to improved postoperative pain control and early mobilization. Further studies are warranted to validate its efficacy and safety in the pediatric population.