الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The enhanced recovery pathway for patients after cardiac surgery must include perioperative pain management as a key element. The etiology of postoperative pain mechanisms is diverse and multifactorial. Skin incision, dissection, sternal retraction, internal mammary artery graft preparation, installation of chest drains, and sternal wires are all procedures that cause tissue damage directly.
Untreated acute pain can turn into chronic pain in 30% to 50% of patients who have had heart surgery. Poor pain management can have a crippling impact on the postoperative course, including pulmonary problems, myocardial infarction, increased thromboembolic events, and delayed wound healing.
Chest wall innervation depends mainly on typical intercostal nerves with their lateral and anterior cutaneous branches. The sternum, ribs, and surrounding tissue are innervated by the intercostal nerves that emerge from the thoracic nerve roots.
Multimodal analgesia is recommended through pharmacological management as well as regional anesthetic techniques. The pharmacological management includes paracetamol, NSAIDs, alpha 2 agonists, and opioids.
There are different options for post cardiac regional anesthesia such as epidural, paravertebral block, and erector spinae block. However, epidural carries a risk of epidural hematoma and sympathectomy. Paravertebral block also carries risk of hematoma and pneumothorax.
Due to their accessibility and increased effectiveness, chest wall blocks have grown in popularity. The Pecto-intercostal fascial plane block and the Transversus thoracic muscle plane block are examples of chest wall blocks.
The anterior cutaneous branches of the intercostal nerves, which run in the fascial plane between the pectoral and intercostal muscles and emerge on each side of the sternum, are the focus of the Pecto-intercostal fascial plane block (PIFB). PIFB is asserted to be less dangerous than transversus thoracic muscle plane block, which raises the possibility of internal mammary artery damage.
The current study aimed to compare ultrasound-guided PIFPB versus sham block in patients selected for cardiac surgery as regards the analgesic profile by using VAS score, time of extubation, frequency, and total amount of rescue analgesic consumed in the 1st 24 hrs. postoperative.
After approval of the Alexandria Faculty of Medicine Ethics Committee and obtaining written informed consent from patients, the present study will be carried out in Alexandria Smouha University Hospital on 80 patients undergoing open cardiac surgeries using median sternotomy.
Exclusion Criteria: