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Background and Aims Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting young infants, usually diagnosed during the first 3–5 weeks of life. It is characterized by an obstruction of the gastric outlet causing immediate postprandial vomiting. The treatment is surgical, by pyloromyotomy (open or laparoscopic), thus requiring anesthetic intervention. The main concerns for the anesthesia team, after guaranteeing adequate hydration and electrolyte balance, are not only the specificities of the neonate and early infant, but the risk for pulmonary aspiration and adequate analgesia. The rectus sheath block (RSB) is a useful analgesic option.Methods This abstract presents a tertiary center’s experience with IHPS and the use of RSB for open pyloromyotomy, in 2024 and early 2025.Results In this period 4 infants with IHPS had a pyloromyotomy performed under general anesthesia (GA) combined with a RSB. The average age of intervention was 4.5 weeks and the average weight was 3570 g. In every case the RSB was performed bilaterally, after induction of GA, guided by ultrasonography, using ropivacaine 0.1%. Two of them were performed with 1 mL on each side (the babies with the lightest weight) and the other two with 1.5 mL. No complications were identified. Non-opioid systemic analgesia was also administered, namely paracetamol 7.5 mg/kg. Adequate intraoperative analgesia was achieved, without need for further opioid doses beyond induction.Conclusions The RSB is a simple and effective tool in the pain control of small infants submitted to open pyloromyotomy, a challenging demographic given the limitations in the available pharmacological arsenal.