Group (A): This group will receive fentanyl infusion at a dose of (0.5μg/kg/h) all through the whole operation plus ultrasound guided bilateral superficial parasternal intercostal Plane block which will be done by injecting 0.4ml/kg (1:1 solution of bupivacaine 0.25% and lidocaine 1%) at each side3.

Group (B): This group will receive fentanyl infusion at a dose of (0.5μg/kg/h) all through the whole operation plus Ultrasound guided bilateral ESPB which will be done by injecting 0.4ml/kg (1:1 solution of bupivacaine 0.25% and lidocaine 1%) at each side .

Preoperative assessment Premedication Monitoring General Anesthesia induction Arterial and Venous cannulation Fentanyl Infusion Giving block according to the group Intra operative recording of hemodynamics Post operative pain assessment

Inclusion Criteria:

• RACHS-1: Categories 1, 2 and 3
• Patients undergoing corrective cardiac surgeries with midline sternotomy incision.
• Redo surgeries.

Exclusion Criteria:

• Patients whose parents or legal guardians refuse to participate.
• Preoperative mechanical ventilation.
• Preoperative inotropic drug infusion.
• Coagulopathy.
• Allergy to any of the studied drugs.
• Severe pulmonary hypertension (> 70 mmHg).

yes

2026

Any