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Background and Aims The erector spinae plane block (ESPB) was first described by Ferero et al. in 2016 for the treatment of chronic thoracic neuropathic pain and postoperative pain in thoracic surgery. Various applications of the ESPB in intra- and postoperative analgesia have since been investigated. Shoulder arthroscopy is commonly performed under brachial plexus block. However, to our knowledge, there is no literature on regional anesthesia for tendon transfer from torso muscles in shoulder surgery. We present a successful case of arthroscopic rotator cuff tear repair with latissimus dorsi tendon transfer under combined brachial plexus superior trunk block and thoracic Erector Spinae Plane block (T-ESPB).Methods A male patient, 47, with a BMI of 25.4 and smoking history of 60 pack-years presented for shoulder arthroscopy and latissimus dorsi tendon transfer due to rotator cuff tear. He had no chronic health issues and was on no regular medications. During his preanesthetic evaluation, our patient expressed a preference for regional anesthesia after hearing his options. Our anesthetic plan included a brachial plexus superior trunk block for shoulder anesthesia, and a T-ESPB for the tendon transfer. The superior trunk block was performed under ultrasound guidance and electrical nerve stimulation. The T-ESPB was performed under ultrasound guidance at the fourth thoracic vertebral level. Ropivacaine 0.375% was used at a total dose of 45 ml. No opioids were used. A 10-minute infusion of 1 μg/kg of dexmedetomidine was administered.Results The patient remained conscious, calm and cooperative throughout surgery (125 minutes). Adequate postoperative pain control was achieved with 1 g of paracetamol every six hours and 50 mg of dexketoprofen every eight hours. Our patient was discharged the following day.Conclusions The T-ESPB was safe and effective in providing surgical anesthesia for our patient’s latissimus dorsi tendon transfer. Our case warrants further investigation of this novel application of the T-ESPB.