Cancer pain is defined as an unpleasant sensory and emotional experience. 90% of patients with terminal cancer present pain. An alternative for the management of pain located in the thorax is erector spinae plane (ESP) block guided by real-time ultrasound. However, its use in the management of oncological chest pain is not very common, with few reports in this regard, with most of these reports always performed by anesthesiologists. We describe our first experience performing a real-time guided ESP block using ultrasound performed by a trained pulmonologist in a 64 years-old male with lung adenocarcinoma stage IVa with sternum metastases and multiple left costal arches associated with left pleural effusion due to pleural metastases. We found ESP block to be safe for the patient as well as effective in reducing pain measured by Visual Analogic Score and was able to reduce the use of systemic analgesics.