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Background and Aims Chronic low back pain originating from the lower lumbar facet joints is a frequent complaint in routine pain practice and the resulting myofascial strain often leads to an acute exacerbation. Sacral erector spinae plane (ESP) block at S2–4 has been used in the past for relieving chronic anorectal pain, acute lumbar radicular pain and chronic coccygodynia. We hypothesized that ultrasound-guided sacral ESP block at S1 level may be performed for low back pain that is presumed to be facetogenic in origin.Methods Patients presenting to the outpatient department for low back pain were clinically evaluated. Patients aged 18–80 years with predominantly axial back pain with a numerical rating score (NRS) of 5–8 associated with unilateral paramedian tenderness at the lower lumbar levels (L4–5/L5-S1) and a positive facet loading on examination were selected for intervention. Sacral ESP block was performed at S1 level, lateral to the foramen at the intermediate crest using a low frequency ultrasound probe (2–6 Hz, GE Venue machine) with 10 ml of 0.2% ropivacaine.( Figure 1,2) Charts were reviewed for demographic profiles, history/examination findings, procedure performed, NRS, Oswestry Disability Index (ODI) scores and complications.Results The records of 15 patients who underwent ultrasound-guided sacral ESP block for facetogenic pain were assessed. The average age was 64.5 years and 60% patients were female. 13/15 patients (86%) reported a > 50% decrease in NRS whilst 11/15 patients (73%) patients reported a 10-point reduction in ODI scores at 2 weeks. No complications were noted in any of the patients. ( Figure 2 and table 1)Conclusions Sacral ESP block performed at the S1 level is a safe and effective technique with easily identifiable sonographic landmarks for chronic low back pain of facetogenic origin. .Abstract EP083 Figure 1Arrow marking for needle end pointAbstract EP083 Figure 2Sacral multifidus plane injection sonoimageAbstract EP083 Table 1Clinical charcteristics of patients undergone sacral multifidus plane block