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Application for ESRA Abstract Prizes:Background and Aims Enhanced Recovery After Cardiac Surgery (ERACS) is a novel, multimodal approach aimed at improving postoperative outcomes through optimized perioperative care. A core principle is minimizing opioid use to reduce associated side effects and facilitate faster recovery. The erector spinae plane (ESP) block, a simple regional anaesthesia technique, may support this goal by providing effective, opioid-sparing analgesia. This case series evaluates the efficacy and safety of bilateral ESP blocks in facilitating enhanced recovery in patients undergoing cardiac surgery via median sternotomy.Methods Ten adult patients scheduled for elective cardiac surgery received bilateral ultrasound-guided ESP catheters at T5-T6. Prior to induction, 20 mL of 1% Lidocaine and 20 mL of 0.25% Levobupivacaine were administered on each side. At surgery completion, 30 mL of 0.25% Levobupivacaine was given through each catheter, with repeat doses at 12 and 24 hours. All patients received regular paracetamol; opioids were reserved for rescue analgesia. Data collected included opioid consumption over 48 hours, pain scores (NRS), time to extubation, and block-related complications.Results ESP blocks were successfully administered in all patients without complications. Opioid consumption was significantly reduced, with NRS scores consistently <3/10 at rest and on coughing. All patients were extubated within 6 hours postoperatively; three were extubated within 2 hours. No block-related adverse events occurred.Abstract P332 Figure 1ESP blockConclusions Bilateral ESP blocks offer safe, effective analgesia in cardiac surgery, supporting ERACS goals. Their use may reduce chronic sternal wound pain and should be evaluated further in larger studies.