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Background and Aims Thoracic paravertebral block is an effective regional anesthesia technique for unilateral analgesia, and has seen a dramatic increase in use among pediatric patients presenting for surgery. However, its use in very young infants is not well-documented; there is also limited literature focusing on the developmental anatomy of the pediatric paravertebral space and clinical validation of formula-based approaches. We present the youngest case of paravertebral block performed at our institution – a two-month old infant undergoing repair of congenital diaphragmatic hernia.Methods Under general anesthesia, a single-shot thoracic paravertebral block was performed at T6 level using real-time ultrasound guidance. Actual paravertebral space depth was measured sonographically and compared with depth estimated using a landmark and weight-based formula.Results The actual PVS depth closely matched the estimated value. The block provided effective intraoperative and postoperative analgesia, minimized opioid use, and was associated with no complications.Conclusions This case highlights the feasibility, safety, and effectiveness of ultrasound-guided PVB in infants. As the youngest reported case at our institution, this contributes to the growing evidence supporting the use of regional anesthesia in neonates and young infants. This also validates the accuracy of the Ponde and Desai1 formula, achieving precise needle and local anesthetic placement, satisfactory analgesia, and clinical evidence in line with theoretical estimations of block depth.