AnErector Spinae Plane (ESP) Block is performed in the plane between the Erector Spinae muscles and the transverse processes of the vertebral column.

•This block is most usually done peri-operatively for pain control in cardiac, thoracic, abdominal, and spine surgeries.

•Recently this block has been performed outpatient for chronic pain. Typically done under ultrasound, however 4 case reports have reported good outcomes under fluoroscopy. No studies have looked at outpatient ESP blocks under fluoroscopy.

•Benefits of fluoroscopyinclude visualization of exact location of needle, easier TP recognition, confirmation ofappropriateplane access with contrast, and monitoring of intravascular uptake.

•Benefits of ultrasound include avoidance ofradiation hazardsand sufficient scientific literature support for success and safety. This method is preferred in populations such as pediatricor pregnant patients.

•We present a successful case of fluoroscopyguided ESPblockperformed due topoor visualization under ultrasound.