Intertransverse Process Block to Improve Quality of Recovery After Cardiac Surgery With Sternotomy

The goal of this clinical trial is to evaluate the efficacy of intertransverse process block (ITPB) in blunting sympathetic response of sternotomy, achieving perioperative opioid-sparing and improving quality of recovery in adult patients undergoing elective cardiac surgery (e.g., coronary artery bypass graft \[CABG\], valve repair/replacement, or combined CABG/valve procedures).

The main questions it aims to answer are:

1. To investigate the efficacy of intertransverse process block (ITPB) on quality of recovery after cardiac surgery 2. To investigate the efficacy of ITPB on the sympathetic response on incision, intraoperative and postoperative morphine requirement 3. To investigate the efficacy of ITPB on surgical outcomes including time to weaning off mechanical ventilation, length of ICU/ hospital stay and incidence of neuropathic pain after surgery Researchers will compare patients receiving bilateral ITPB with levobupivacaine to those receiving sham blocks to determine if ITPB reduces CPSP, improves pain control, and decreases opioid consumption.