Pectointercostal Fascial Plane Block (PIFB) Alone Versus PIFB With Rectus Sheath Block (RSB) in Cardiac Surgery

Inclusion Criteria: * Subjects scheduled for cardiac surgery involving primary median sternotomy and mediastinal chest tubes. * Age 18-85 years of age * BMI 18-50 kg/m2 * Weight \> 60 kg Exclusion Criteria: * Left ventricular ejection fraction (LVEF) \< 30% * Preoperative, intraoperative, or immediate post-operative placement of intra-aortic balloon pump or deployment of extra-corporeal membrane oxygenation (ECMO) * Inability to understand or speak English * Allergy to bupivacaine or other amide local anesthetic * Contraindication to peripheral nerve block (e.g. local infection, previous trauma to the block site) * Chronic opioid consumption (daily oral morphine equivalent of \>20 mg) in the past three months * Severe pulmonary or hepatic disease * Neurological deficit or disorder * Suspected or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past two years * Uncontrolled anxiety, schizophrenia, or other severe psychiatric disorder