The aim of this study is to compare the analgesic effects of ultrasound-guided bilateral erector spinae plane block versus ultrasound-guided bilateral combined Pecto-intercostal fascial plane block and recto-intercostal fascial plane block in patients undergoing cardiac surgery.
Age from 21 to 65 years.
Both sexes.
Scheduled for open heart surgery with cardiopulmonary bypass and midline sternotomy.
History of chronic pain or Long-term or recent use of opioids.
History of allergy to local anesthetic drugs.
Ejection fraction of left ventricle less than 30%.
History of psychiatric diseases or any neurological disorders.
Parallel
Erector spinae plane block
DrugThe block will be done under ultrasound guidance using 20 ml bupivacaine 0.25% that will be injected for each side ensuring not to exceed the maximal 2 mg/kg bupivacaine dose.
Combined Pecto-intercostal and recto-intercostal fascial plane block
DrugThe blocks will be done under ultrasound guidance using 10-15 ml of 0.25% bupivacaine that will be injected for each side ensuring not to exceed the maximal 2 mg/kg bupivacaine dose..
The total opioid consumption in first 24 hours after surgery.
opioid analgesia will be given if the pain scores ≥ 4.
Intraoperative fentanyl dose
Fentanyl bolus dosages of 2μg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline.
Postoperative pain scores after extubation, at 8, 12, 18, 24, 36, and 48 hour after surgery.
Numerical rating scale pain score (NRS) ranges from 0= no pain to 10= worst pain will be used to evaluate pain scores after surgery.
Extubation time
Time from intensive care unit admission until successful removal of endotracheal tube will be recorded.
Side effects
Hypotension , bradycardia, postoperative nausea and vomiting
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