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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims A 25-year-old male presented following a motor vehicle accident with multiple right-sided rib fractures, pulmonary contusion, a small pneumothorax, and thoracolumbar spine fractures ( figures 1, 2). Due to the extent of his injuries, emergency spinal fusion was indicated. On admission, he was hemodynamically stable but had hypoxemia (SpO2 95% on 50% Venturi mask, 91% on room air), tachypnea, dyspnea, and severe inspiratory pain.Methods To optimize analgesia and limit respiratory depression, an ultrasound-guided erector spinae plane (ESP) block was performed at the T8 level. General anesthesia included sevoflurane (1–1.2%) and fentanyl (250 µg). Surgery lasted two hours. Postoperatively, pain relief and oxygenation improved significantly ( figure 3).Results Mild pain (VAS 2/10) recurred after 20 hours, and a continuous ESP block was initiated using ropivacaine 2% (6 ml/h), maintained for 60 hours. Upon completion, oxygen saturation on room air was 96%. The patient was discharged on postoperative day 5.Abstract P220 Figure 1Vertebrae fractureAbstract P220 Figure 2Rib fracturesAbstract P220 Figure 3Spine fusion, small right pneumothorax, ESP catheterConclusions To our knowledge, this is the first case describing the use of an ESP block for thoracolumbar spinal fusion in a patient with rib fractures and hypoxemia. In such scenarios, the ESP block offers not only effective analgesia but also prevention of respiratory complications such as atelectasis, pneumonia, and worsening hypoxemia. It facilitates timely surgical intervention, reduces morbidity, and shortens hospitalization.