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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 A significant postoperative pain has been documented in numerous breast cancer cases following modified radical mastectomy (MRM). We evaluated the effect of ketamine as an adjuvant to local anesthetic in erector spinae plane block (ESPB) in MRM Surgery.Methods In this randomized controlled trial, 50 women with breast cancer aged 18 to 70 years and scheduled for MRM were included and randomized into two equal groups. Patients in group A received USG guided ESPB with 30 ml of 0.25% bupivacaine alone whereas patients in group B received the same along with 1 mg/kg ketamine. In the postoperative period, Numerical Rating Scale(NRS) score, DN4 score by Douleur Neuropathique Questionnaire(DN4 Questionnaire), cumulative opioid consumption in 24 hours, time to rescue analgesia, PONV scores and sedation scores were noted in both the groups.Results No significant difference was seen in NRS at 1 hour (p= 0.697), at 2 hours (p=0.069), at 4 hours (p= 0.415), at 8 hours (p=0.217), at 12 hours (p= 0.054), at 24 hours (p= 0.452) between group A and B. Similarly, cumulative opioid consumption in 24 hours, DN4 scores, time to rescue analgesia, PONV scores and sedation scores were comparable in both the groups.Conclusions Our study did not demonstrate any benefit of adding Ketamine to Bupivacaine in a single shot USG guided Erector Spinae block in patients undergoing modified radical mastectomy. However, this was a preliminary study with a small sample size. Thus, larger studies may provide more generalized results.