Efficacy of Ultrasound Guided PIFB Versus Lidocaine Infusion on Postoperative Pain After Sternotomy

Chronic pain is a common complication after cardiothoracic surgery. The prevalence of post-sternoyomy pain syndrome (PSPS) ranges from 33% to 91%. Exact pathogenetic mechanisms for developing chronic pain after sternotomy are unknown. Apart from intraoperative nerve damage and subsequent postoperative neuropathic pain, operation techniques, age, sex, pre-existing pain, genetic and psychosocial factors, severe postoperative pain, and analgesic management are suspected to have an impact on the development of PSPS .

Inclusion Criteria: 1. age between 18 and 75 years. 2. patient scheduled to undergo elective on-pump cardiac surgery with sternotomy. 3. American Society of Anesthesiologists classification of physical status \< IV. Exclusion Criteria: 1. emergency surgery. 2. off-pump surgery. 3. redo surgery. 4. ejection fraction less than 35%. 5. refusal of the patient. 6. known hypersensitivity to LA. 7. chronic opioid use or chronic pain patient. 8. psychiatric problems or communication difficulties. 9. liver insufficiency (defined as a serum bilirubin ≥ 34 μmol/l, albumin ≤ 35 g/dl, INR ≥ 1.7). 10. renal insufficiency (defined as a glomerular filtration rate \< 44 ml/min). 11. obstructive sleep apnea syndrom. 12. coexisting hematologic disorders. 13. pregnancy or breastfeeding.