Parasternal Nerve Block in Cardiac Patients

Exclusion Criteria

• •Concomitant cardiac procedures (e.g. aortic valve repair/replacement, mitral valve repair/replacement, aortic root replacements).
• •Redo sternotomy.
• •\< 50 kg (Exparel® is currently only approved in patients \> 50 kg).
• •Pregnant or nursing
• •History of alcohol, narcotic or illicit drug abuse
• •Participation in another study evaluating investigational medications within the past 30 days
• •Taking narcotic analgesics within 3 days pre-operatively or perioperative stress-dose steroids.
• •Chronic non-cardiac pain (e.g. lower back pain, fibromyalgia) requiring narcotic analgesics.
• •Pre-operative mild liver insufficiency as defined by liver function tests \[(i.e. alanine aminotransferase (ALT), aspartate aminotransferase (AST)\] ≥ 1.5 times the upper limit of normal (ULN: ALT: 0-35 U/L, AST: 0-35 U/L, Alk Phos 35-105 U/L, Total bilirubin: 0-1.2 mg/dL)
• •Pre-operative mild renal insufficiency (Cr ≥ 1.5 mg/dL)
• •Allergy to amide-type anesthetics
• •Recurrent ventricular arrhythmias, low cardiac output requiring inotrope and/or intra-aortic balloon pump support, left ventricular ejection fraction \< 30% at time of pre-operative screening/evaluation.
• •Unable to provide informed consent or unable to understand how to use pain rating scales.
• •Inability to understand or operate the patient-controlled analgesia (PCA) machine.