Background and aims Postoperative pain is a risk factor for increased morbidity due to respiratory system dysfunction, hemodynamic effects and arrhythmia, especially in pediatric cardiac surgery. Central neuraxial blocks are not preferred because of potential neurological complications in these heparinized patients. Peripheral nerve blocks have become a good choice for adequate pain relief in pediatric heart surgery as well as reducing systemic stress response and opioid consumption. the aim of the study was to evaluate the analgesic efficacy of ultrasound guided parasternal subpectoral intercostal plane block in pediatric cardiac surgery.

Methods Five patients, aged between 6- 24 months, scheduled ventricular septal defect closure (VSD) procedure, in extubated children within the postoperative first 2 hours were include the study. Single shot USG guided parasternal subpectoral intercostal plane block was administered after intubation bilaterally (0.5 ml/kg,% 0.25 Bupivacaine). After extubation FLACC scores (pain rating scale for infants- 7 years of age) every 3 hours, opioid consumption were saved.

Results FLACC scores were significantly lower at all measured time points. Fentanyl consumption significantly decreased, hemodynamic data were stable and complication not observed.

Conclusions Pain after sternotomy affects especially breathing depth, effective cough and causes respiratory complications such as atelectasis and hypoxia, in pediatric patients. Generally used high-dose opioid is not preferred in patients planned for early extubation because of side effects. Our study shown that parasternal subpectoral intercostal plan block is a safe and effective pain relief technique in the first 24 hours in children undergoing heart surgery.