Bilateral Two Levels Serratus Anterior Plane Block in Pediatric Cardiac Surgery With Median Sternotomy

A bilateral two-level SAPB will be performed with the guidance of ultrasound. While the patient is in the supine position with their arms abducted, the ribs will be counted down from the second rib at the level of manubriosternal joint, the mid- axillary line will be demarcated where the probe will be placed in the longitudinal plane to visualize the ribs and the overlying muscles. Using in- plane approach, a 22-gauge short bevel needle will be inserted and advanced to the plane between the latissimus dorsi muscle and the serratus muscle under sono-visualization at the level of 3rd and 6th ribs bilaterally in succession over which a total volume of 1ml/kg bupivacaine 0.25% will be divided and injected (0.5ml/kg on each side); with total dose not exceeding 2.5 mg/kg

Intraoperative opioids without regional block