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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims The erector spinae plane (ESP) block has been increasingly used as a regional analgesia technique to enhance postoperative pain control while reducing opioid consumption. This case report describes a 62-year-old woman undergoing elective on-pump coronary artery bypass grafting via median sternotomy, aiming to evaluate the effectiveness of ESP block as part of a multimodal analgesia strategy.Methods As part of a randomized, double-blind clinical trial, the patient received bilateral ESP block with either 0.2% ropivacaine or placebo, followed by patient-controlled analgesia (PCA). The block was performed under ultrasound guidance before surgery. Postoperative pain was assessed using the Numerical Rating Scale (NRS) for five days. PCA infusion volumes and bolus counts were also monitored.Results Pain peaked on postoperative day 1 (10/10 during mobilization) and progressively declined. By day 2, the patient reported 0/10 pain scores at rest and during mobilization ( table 1). PCA demand increased until catheter removal on day 3 (figure 1). On day 5, a pain score of 7/10 during mobilization was reported, likely due to the discontinuation of PCA. The patient remained stable with no complications.Abstract P209 Table 1The table shows the results of the numeric rating scale (NRS) during rest and mobilization, in the morning (M), afternoon (A), and evening (N) over the five postoperative (PO) daysAbstract P209 Figure 1The graph shows the volume of anesthetic administered by the patient-controlled analgesia (PCA) pumps and the highest numeric rating scale (NRS) value recorded per day over the five postoperative daysConclusions This case supports the potential role of ESP block in reducing postoperative pain and facilitating early recovery following cardiac surgery. Despite group allocation remaining blinded, clinical evolution suggests effective analgesia. Further studies are needed to confirm its role in fast-track protocols.