الفهرس 
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Abstract
This prospective, double-blind, randomized study was carried out at the department of anesthesia and intensive care in Minia-University Hospital and Assuit university hospital during the period from December 2016 till June 2017 on a total 60 pediatric patients (ASA) physical status II who underwent cardiac surgery with median sternotomy under general anesthesia after institutional approval and informed consents obtained from all patients prior to performing the study.
The aim of this work was to study and compare the effect of parasternal intercostal block using bupivacaine on pediatrics undergoing cardiac surgery and to measure the effect of this block on opioid requirement and to evaluate the extubation time
Patients enrolled into the study were divided into two equal groups of 30 patients in each group:-
Bupivacaine group (p group): (bupivacaine group)
The patients in this group received a parasternal intercostal block with 0.25% bupivacaine in a dose of 0.08 ml /kg /space in each intercostal space close to the sternum beginning from the second to the sixth space on each side.
Control group (S group): (saline group)
Normal saline were injected in a dose of 0.08 ml /kg /space in each intercostal space close to the sternum beginning from the second to the sixth space on each side.
The two groups were compared with respect to:-
1- Time to extubation
2- MOPS at 1,2,3,4,6,8,10,12,14,16,18,20,22 and 24 hrs postoperative.
3- Hemodynamics including Heart rate and Blood pressure at 1,2,3,4,6,8,10,12,14,16,18,20,22 and 24 hrs postoperatively.
4- Cumulative fentanyl consumption in 1st 24 hrs postoperatively.
5- Possible side effects.
There was lower statistically significant difference inthe mean heart rate in bupivacaine group compared to saline group at 1h,2h, 3h,4h, 6h, 8h10h, 12h, 14h,16h and 18 hours postoperatively.
The postoperative modified objective pain score was significantly lower in bupivacaine in comparison to saline group at 1h,2h,3h,4h, 6h,8h, 10h, 12h, 14h,16h and 18hours postoperative period.
Comparison between the two groups detected a lower statistically significant difference in the time to extubation in bupivacaine group compared to saline group.
The total amount of postoperative 24h fentanyl consumption was significantly lower in bupivacaine group compared to saline group.
There was no detected side effects neither to the technique nor to the injected drug.
Conclusion
This research have shown that practically bupivacaine 0.25% is effective to control postoperative sternal wound pain after cardiac surgery. A local anesthetic parasternal intercostal block with bupivacaine results in less postoperative pain and reduced consumption of fentanyl and adjunctive analgesia in the general cardiac surgery population.