الفهرس 
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Abstract
Inadequate post-operative pain control is a significant problem faced by many patients undergoing open cardiac surgeries. Poorly controlled pain leads to various hemodynamic changes including tachycardia and hypertension, which cause increased myocardial oxygen demand. In addition, inadequate pain control results in decreased mobilization, increased morbidity and longer lengths of hospital stay. Regional anesthetic techniques have provided better quality of acute pain control and subsequently less incidence of chronic pain. The use of ultrasound as an aid for accurate placement of local anesthetic is gaining in popularity for regional anesthesia. Ultrasound guided Parasternal blocks using local anesthetics target the anterior intercostal nerves just lateral to the sternum. They have been shown to provide adequate post-operative pain control and decrease opiate requirements with low risk of complications. This study was carried out in Tanta University Hospitals from November 2021 to January 2023 on 90 adult patients of both sexes aged (21- 60) years old and scheduled for elective open cardiac surgery (valve replacement) with midline sternotomy Patients were randomly divided into 3 groups (30 patients each): 1. Control Group: After surgery, patients received only conventional systemic analgesia. 2. Pecto-intercostal fascial plane block group (PIFB Group): After surgery, patients received conventional systemic analgesia in addition to bilateral PIFB with injection of 20 ml of local anesthetic solution (19 mL of 0.25% bupivacaine plus 1 ml of 4 mg dexamethasone). 3. Transversus thoracis muscle plane block group (TTPB Group): After surgery, patients received conventional systemic analgesia in addition to bilateral TTPB on each side with injection of 20 ml of local anesthetic solution (19 mL of 0.25% bupivacaine plus 1 ml of 4 mg dexamethasone.) The primary outcome was post-operative pain score measured at (0,3, 6, 12, and 24 h), the secondary outcomes were: the onset of first rescue analgesic request, total opioid consumption in first 24 hours postoperative, duration of mechanical ventilation & the incidence of complications (hematoma, pneumothorax, local anesthetic toxicity) The results of our study showed that: There was no statistically significant differences among the three groups as regards patients’ demographic data (age, gender, weight) as well as, type of procedure, cardiac bypass time, duration of operation and intraoperative fentanyl consumption (μg)) there was a statistically significant decrease in NRS values in the PIFB group and the TTB group as compared to the control group at (0, 3, 6hr), with no significant difference among the three studied groups at (12 hr, 24 hr). in addition, no significant differences were observed between the PIFB group as compared to the TTB group at different times of measurement There was a significant delay in the onset of first rescue analgesia, together with a significant decrease in the total 24 hr rescue fentanyl consumption and significantly less duration of MV in the PIFB group and the TTB group as compared to control group with no significant differences between PIFB group and TTB group at these measurements. Hematoma was observed in two patients in the PIFB group (6.6 %) and three patients in the TTB group (10%) and only one patient in the TTB group (3.3%) experienced pneumothorax.