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Background and Aims Erector spinae plane block (ESPB) has been increasingly used in surgical pain management for many procedures, including in pediatric patients. ESPB’s mechanism of action is still not completely understood. The target location for local anesthetic administration, timing, and pharmacological approach varies in the literature. Evidence of the effectiveness of ESPB is controversial and limited, especially in pediatrics, but recent reports show a promising regional technique for perioperative pain control in these patients.

Methods We report a case of a 4-month-old girl, ASA-PS II, weighing 6,2Kg, scheduled for an open pyeloplasty with ureteral stent substitution for left pyelo-ureteral junction syndrome.

Results We decided to perform a combined anesthesia, with ESPB for perioperative analgesia. After general anesthesia induction, a single-shot left ESPB at T9 level was performed under ultrasonography guidance. A total of 0,5 mL/Kg of ropivacaine 0.2% was injected. Anesthesia was maintained with sevoflurane. A multimodal analgesia regimen also included intravenous ketamine (0,3mg/kg), acetaminophen (10mg/kg) and ketorolac (0,5mg/kg). Hemodynamic stability was maintained throughout the procedure (120min). The postoperative pain FLACC score was 0/10 in PACU and over the next 48 hours of hospitalization. No rescue analgesia was need during hospital stay, namely opioids.

Conclusions A continuous ESPB for open pyeloplasty in an infant has been reported. We present a case of successful single-shot ESPB analgesia, suggesting it can be a part of an effective multimodal analgesia regimen for the management of acute postoperative pain after open pyeloplasty in pediatric patients with opioid sparing.