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Application for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Coccygectomy is a treatment of last resort for chronic coccydynia unresponsive to conservative therapy. While general and neuraxial anesthesia are commonly preferred, the Sacral Multifidus Plane Block (SMPB) may provide a safer and more comfortable regional anesthesia alternative. We present two cases where SMPB was used as the primary anesthetic technique for coccygectomy.Methods Two female patients underwent ultrasound-guided SMPB at the S2-S4 level. With patients in the prone position, under ultrasound guidance, the needle was advanced in a caudocranial direction using an in-plane approach, targeting the fascial plane between the sacrum and the multifidus muscles. A total of 20 mL of 0.5% bupivacaine was administered to this area, targeting the midline to ensure sufficient bilateral spread. Sensory block was assessed every 5 minutes using pinprick testing. After confirming adequate sensory block, sedation during surgery was maintained using dexmedetomidine.Results Both patients successfully underwent the surgical procedure with the SMPB as the sole anesthetic technique, without the necessity for conversion to general anesthesia. Case 1: Pain sensation was fully absent by the 10th minute and sensory block covered T12-S3. Transient right leg motor weakness (4/5) and numbness in the right foot were noted. No analgesics were required during or after surgery, with a maximum numeric rating scale (NRS) score of 4 within 24 hours. Case 2: Pain sensation disappeared by the 15th minute and block range was L4-S3. No motor deficits occurred. Intravenous paracetamol (1 g twice daily) was administered postoperatively for pain (max NRS 5). Patients were discharged the next day without complications and reported no analgesic need at one month.Abstract P136 Figure 1USG-guided sacral multifidus plane block and local anesthetic spreadConclusions SMPB offers a promising, effective, and safe anesthetic option for coccygectomy, providing reliable analgesia and facilitating recovery. Further research is essential to evaluate its broader applications in pelvic and sacral surgeries.