Efficacy of Multiple Nerve Blocks on the Recovery of Patients Undergoing Off Pump CABG Surgeries

In cardiac surgery patients , effective pain control is crucial to support early extubation, mobilization, and cognitive recovery, yet systemic opioids carry substantial risks such as respiratory depression, delirium, and delayed rehabilitation. While regional fascial plane blocks offer a safer, opioid-sparing alternative, no single technique provides complete analgesia for the complex and multi-dermatomal pain generated by sternotomy, graft harvesting, chest wall retraction, and drain sites. Therefore, a multimodal approach combining blocks such as parasternal nerve block , rectus sheath nerve block and femoral nerve block , may cover most of areas expected to be sources of intraoperative and post-operative pain in cardiac surgery patients.

Inclusion Criteria: * o Scheduled for elective off-pump coronary artery bypass graft (OPCAB) surgery via median sternotomy * American Society of Anesthesiologists (ASA) physical status III - IV * Ability to provide informed consent Exclusion Criteria: * o Emergency or redo cardiac surgery * On-pump CABG or concomitant valve or aortic procedures * Known allergy to local anesthetics or study drugs * Coagulopathy or ongoing anticoagulant therapy contraindicating regional block * Preoperative chronic opioid use or opioid dependency * Neurologic or psychiatric conditions interfering with pain assessment * Infection at the block injection site * Severe hepatic or renal impairment * Body mass index (BMI) \> 40 kg/m² * Inability to understand or cooperate with pain scoring or postoperative care.