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Background and Aims Sacral erector spinae plane(SESP) block is a variant of erector spinae plane block(ESPB) at the sacral level, which has been deemed effective for various perineal and pelvic procedures. It is less invasive and safer compared to the lumbar ESPB. In our experience, this block provides effective analgesia for lumbosacral spine surgeries.(1) Hence, we planned this RCT to establish the analgesic efficacy of SESP block in lumbosacral spine surgeries.Methods Adult patients undergoing elective TLIF surgeries at L5-S1 level were randomised into two groups, Group S (sacral ESPB, N=38) and Group C (Control, N=38). Ultrasound-guided sacral ESPB was performed using ultrasound with 20 ml of 0.25% Ropivacaine with 4 mg dexamethasone on each side at the level of S2. Both groups received PCA fentanyl postoperatively. Total intra and postoperative fentanyl consumption in 24 h, hemodynamic parameters, time to first analgesia, NRS scores at rest and on movement, patient satisfaction, quality of sleep(QOS), and quality of recovery (QoR-15) scores were noted.Results Mean(SD) post-operative fentanyl consumption was significantly in Group S [276.32(148.29) vs.500(209.81) µg;p<0.001].( Figure 1) The mean difference (95% CI) was -223.68 µg (306.73 to -41.67). Group S had a significantly longer mean(SD) TTFA [259.21 (87.63) vs. 106.84 (75.21) min; P<0.001]. Pain scores were significantly lower in the Block group, both at rest and during movement. In SESP group, 52.6% of patients rated their satisfaction level as ‘Excellent’ compared to 39.5% in the Control group(p=0.36). Postoperative mean (SD) QOS [6.42 (0.85) vs. 7.05 (0.84); P=0.002] and QOR-15 scores were significantly better in the group S.Abstract OP65 Figure 1Postoperative fentanyl consumptionConclusions This study highlights the sacral ESP block as a simple, yet valuable addition to the analgesic armamentarium for lumbosacral spine surgeries. By providing superior pain relief, minimizing opioid consumption, and enhancing recovery quality, the sacral ESP block addresses key challenges in perioperative pain management in lumbosacral spine fusion surgeries.