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Background and Aims Upper abdominal surgery, particularly hepatic procedures, is associated with significant postoperative pain. While regional analgesic techniques help reduce opioid requirements, neuraxial approaches such as epidural analgesia may be contraindicated due to neuraxial tumor invasion, coagulopathy, or planned anticoagulation for vascular repair. The External Oblique Intercostal (EOI) block is an ultrasound-guided, low-risk technique providing somatic analgesia for upper abdominal surgery. This case highlights the use of bilateral EOI catheters for postoperative pain management in an infant undergoing hepatic tumor resection.Methods A 13-month-old, 9.0 kg infant with no significant past medical history presented with abdominal distension and a complex cystic liver mass, requiring exploratory laparotomy. After induction and intubation, anesthesia was maintained with sevoflurane, dexmedetomidine, and intermittent fentanyl boluses. Bilateral EOI blocks were performed preoperatively. Following sterile preparation, a linear ultrasound probe was positioned at the 6th rib in a paramedian sagittal plane. Using an in-plane technique, an 18G, 100 mm bevel-tip needle was advanced under ultrasound guidance, and 0.5 mL/kg of 0.25% bupivacaine was injected bilaterally. Peripheral nerve catheters were placed and secured at 6 cm at the skin for continuous infusion.Results A laparatomy was performed via a chevron incision, and the left liver mass and gallbladder were resected. Postoperatively, EOI catheters infused 0.1% ropivacaine at 2.5 mL/h each, supplemented by hydromorphone PCA, acetaminophen, and ketorolac. The catheters and PCA were removed on postoperative day 7, with minimal opioid use beyond the planned PCA.Abstract P108 Figure 1External oblique intercostal plane blockAbstract P108 Figure 2Bilateral external oblique intercostal plane block cathetersConclusions The EOI block effectively covered T6-T10 dermatomes, providing adequate somatic analgesia while avoiding neuraxial risks. This case highlights its potential as an epidural alternative in pediatric patients. However, multimodal analgesia remains essential for visceral pain control.