Analgesic Efficacy of Bilateral US Guided TTPB vs ESPB in Pediatric Patients Undergoing Corrective Cardiac Surgeries

Under strict aseptic precautions, The T3 spinous process will be located. A high-frequency 12 MHz linear US transducer will be placed in a longitudinal orientation 3 cm lateral to the T3 spinous process corresponding to the T2 transverse process. Three muscles; trapezius (uppermost), rhomboids major (middle), and erector spinae (lowermost) will be identified superior to the hyperechoic transverse process. Using in-plane approach a 25 G needle will be inserted in caudal-cephalad direction, until the tip is deep to erector spinae muscle. Correct needle tip location will be confirmed by injecting 3 mL of normal saline and visualizing the linear LA spread (i.e., hydrodissection) in the fascial plane between the erector spinae muscle and the transverse process. Then, 0.4 ml/kg (1:1 solution of bupivacaine 0.25% and lidocaine 1%) will be injected and visualizing the linear LA spread in the fascial plane between the erector spinae muscle and the transverse process.

Under strict aseptic precautions, the T4-T5 intercostal space is identified under US using the US probe in the longitudinal plane 1 cm lateral to the sternal border. A high-frequency linear transducer is used. Next, a parasternal sagittal view of the intercostal muscle and the transverses thoracis muscle between the 4th and 5th rib is visualized above the pleura and a 22G, 5-10 cm needle is inserted in-plane (according to patient's body habitus and relevant anatomy) to the transducer with bevel up until the tip of the needle is located in the transverses thoracis muscles. After excluding intravascular and intrapleural placement, local anesthetic is adminstred bilaterally by injecting 0.4ml/kg (1:1 solution of bupivacaine 0.25% and lidocaine 1%) at each side.