Background and Aims Sacral fractures may present in young adults after high-energy trauma or in elderly and osteoporotic patients after lower-energy falls. Sacral fractures are frequently underdiagnosed and mistreated because they commonly present in patients who are neurologically intact. Surgical treatment through fixation techniques have been developed. Although fusion rates remain high, long-term complications, such as residual pain persist for many patients.

Methods A 48 years-old man, ASA II, was scheduled for posterior arthrodesis from L-3 to the ileum due to sacral fracture. The patient suffered from hypertension, dyslipidemia and diabetes. His laboratory examinations showed no significant alterations

Results Sacral erector spinae plane block (ESPB) was planned for postoperative analgesia as a part of multimodal analgesia (Paracetamol 1g, Ketorolac 30mg and Ketamine 30mg). Following standard anesthesia induction, the patient was placed in the prone position. Sacral ESPB was applied under general anesthesia. With a high frequency linear transducer placed parallel to the median sacral crest we visualised the S1 intermediate sacral crest. With a caudal to cranial in-plane approach we injected 20 mL of ropivacaine 0.20% between the erector spinae muscles and intermediate sacral crest, bilaterally. We noticed the rising up of the muscle above the bone resulting in a caudo-cranial spread of the drug. After the surgery, patient was extubated and transferred to the recovery room. He reported 3/10 NPRS immediately after surgery, with no need of rescue medication.

Conclusions Sacral ESP block can be a useful and safe technique, as a part of multimodal analgesia, to markedly reduce pain in sacral arthrodesis.