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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Ultrasound-guided regional anesthesia is increasingly utilized in pediatric anesthesia to minimize opioid exposure and enhance recovery. The erector spinae plane (ESP) block, originally described for thoracic analgesia, has demonstrated expanding applications in abdominal procedures. We present a case highlighting the feasibility and efficacy of ESP block for postoperative analgesia in a 2-month-old infant undergoing open pyeloplasty.Methods A 2-month-old, 6 kg male infant (ASA I) underwent right-sided Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction. Intraoperative analgesia included intravenous fentanyl (0.5 µg/kg) and paracetamol (15 mg/kg). At the end of surgery, an ESP block was performed at the right T10 level under ultrasound guidance. A linear hockey stick ultrasound probe (L8–18iD, GE HealthCare) was positioned in a parasagittal orientation approximately 2–3 cm lateral to the spinous process. The erector spinae muscle was visualized superficial to the T10 transverse process ( figure 1). A 22G, 50-mm peripheral nerve block needle (Stimuplex®, B. Braun, Bethlehem, PA, USA) was inserted in-plane, in a caudal-to-cranial direction. After negative aspiration, 5 mL of 0.2% bupivacaine was injected deep to the muscle. Spread of the injectate was confirmed in real time.Results The infant remained hemodynamically stable postoperatively. Pain was assessed using the FLACC scale (Faces, Legs, Activity, Cry, Consolability), with scores ≤2 throughout the first 12 hours. No rescue opioids were needed. A single dose of acetaminophen was administered at hour 12. No adverse events occurred. The patient was discharged in good condition on postoperative day 2.Abstract P114 Figure 1Ultrasound-guided erector spinae plane (ESP) block at the T10 level in a 2-month-old infant. (A) Parasagittal ultrasound image showing the transverse processes of the right 9th and 10th thoracic vertebrae (T9 and T10) and the overlying erector spinae muscle (ESM); (B) In-plane needle insertion technique using a linear hockey stick transducer positioned 2–3 cm lateral to the spinous processes under real-time ultrasound guidance; (C) Ultrasound image following the injection of 0.2% bupivacaine demonstrating the spread of local anesthetic (LA) deep to the ESM and over the transverse processes, consistent with a successful ESP blockConclusions This case supports the ESP block as a safe, simple, and effective option for postoperative analgesia in early infancy. Further studies are needed to clarify its role in pediatric anesthesia practice. Its successful application highlights the potential for broader use in routine clinical settings, particularly in opioid-sparing strategies.