Ultrasound-Guided Parasternal/Rectus Sheath Block vs Erector Spinae Plane Block for Pain Control in Cardiac Surgery

Optimal anesthesia in cardiac surgery requires careful management to avoid sympatheticstimulation, with analgesia being central to patient safety and recovery. Traditionally,high‐dose opioids were used, but this approach delays extubation, conflicting withfast‐track protocols that emphasize early extubation. Consequently, opioid‐free analgesiahas gained importance, employing regional techniques such as neuraxial, paravertebral,and fascial plane blocks.Thoracic epidural analgesia (TEA) offers effective pain control and reduces perioperativecardiovascular and respiratory complications. However, its use in anticoagulated patientsraises concern for epidural hematoma. Alternatives like paravertebral and fascial planeblocks provide comparable analgesia with lower risk. The erector spinae plane block(ESPB) reduces analgesic requirements, though deep blocks still pose bleeding risks.Superficial plane blocks are therefore clinically valuable. The parasternal intercostalblock‐targeting anterior cutaneous branches of intercostal nerves‐has emerged as a safeoption for patients undergoing median sternotomy while on anticoagulant or antiplatelettherapy. Additionally, bilateral rectus sheath block can reduce chest tube insertion painafter cardiac surgery.