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Background and Aims Thoracic surgery in infants poses significant anaesthetic and analgesic challenges. Ensuring effective postoperative pain control while minimizing opioid has emerged as a valuable tool in pediatric regional anaesthesia, though reports in infants remain limited.Methods The authors describe the perioperative management of a 5-month-old female infant (6.8 kg) diagnosed with congenital pulmonary airway malformation proposed to elective right mid and lower lobectomy via thoracotomy. After multidisciplinary planning and informed consent of legal guardian, a balanced general anaesthesia was performed using sevoflurane, fentanyl, and rocuronium, followed by standard endotracheal intubation via video laryngoscopy. Intraoperative analgesia was provided with intravenous paracetamol, ketamine, and metamizole. For postoperative multimodal analgesia, a single-shot ultrasound-guided paravertebral block was performed at the T5 level at the end of the procedure using a high-frequency linear probe and a 22G short-bevel needle, with a total of 5 mL of 0.2% ropivacaine being administered.Results Both the procedure and the anaesthetic recovery were uneventful. The infant remained under surveillance in the pediatric intensive care unit for the first 24 hours, remaining eupneic on room air with no signs of respiratory distress and controlled pain with multimodal analgesia, with reduced opioid consumption. The infant was discharged from the hospital six days after the procedure. At a two-month postoperative follow-up visit, there were no reports of respiratory or infectious complications, nor any pain signals.Abstract EP206 Figure 1Pulmonary lobectomy and surgical incisionAbstract EP206 Figure 2After paravertebral blockAbstract EP206 Figure 3Before paravertebral blockConclusions Single-shot paravertebral block may be a safe and effective approach as part of a multimodal analgesic regimen in infants submitted to lobectomy via thoracotomy.