Trial design: Two-parallel arm, double-blind, individually randomized controlled trial.~Primary endpoint:~Fentanyl consumption in the first 48 postoperative hours.~Secondary endpoints:~Pain at rest, Pain on movement, stay in ICU, Postoperative nausea and vomiting (PONV), sedation, Hemothorax, seizures, arrythmias~Inclusion criteria:~Patient between 18 years to 80 years.~Patient to myocardial revascularization by sternotomy~Exclusion criteria:~Patitient for combined surgery ( myocardial revascularization by sternotomy plus valve or maze)~Emergency surgery~Ejecction Fraction less than 35%~Allergy to the local anesthesic.~Allergy to opioids~Patient in who will be technically impossible the application of the blockade~Trial treatment:~Intervention: These patients will receive the protocol multimodal analgesia patients receive on the Colombian Cardiovascular Foundation with Lidocaine 0.5mcg/k. Dexamethasone 8mcg, Fentanyl Bolus: 7mcg/k . infusion of Fentanyl 4 mcg/k/h start after induction , go down to 2 Mcg/k/h during extracorporeal circulation , after extracorporeal circulation the infusion will be suspended of Fentanyl.In this Arm the patient will give a bilateral serratus intercostal plane block, will be performed echo-guided puncture in the line anterior axillar with fifth costal arch, whit 21 ml of anesthetic mass, 20 ml of Levobupivacaine 0.375 and 1 ml (2mg) of dexamethasone. and the postoperative analgesia will be 500mg of acetaminophen oral and Analgesia, patient controlled with Fentanyl 20mcg/bolus~Control:~These patients will receive the protocol multimodal analgesia patients receive on the Colombian Cardiovascular Foundation with Lidocaine 0.5mcg/k. Dexamethasone 8mcg, Fentanyl Bolus: 7mcg/k . infusion of Fentanyl 4 mcg/k/h start after induction , go down to 2 Mcg/k/h during extracorporeal circulation , after extracorporeal circulation the infusion will be suspended of Fentanyl.. and the postoperative analgesia will be 500mg of acetaminophen oral and Analgesia, patient controlled with Fentanyl 20mcg/bolus~Expected sample size, enrollment and expected number of centers:~Sample size = 44 Recruitment start date: 15 january of 2019 Recruitment end date: 15 July of 2019~Follow-up end date:~Number of centers: 1~Statistical considerations:~Intention to treat analysis~The primary outcomes will be analyzed using
Two-parallel arm, double-blind, individually randomized controlled trial.~Primary endpoint:~Fentanyl consumption in the first 48 postoperative hours.~Secondary endpoints:~Pain at rest, Pain on movement, stay in ICU, Postoperative nausea and vomiting (PONV), sedation, Hemothorax, seizures, arrythmias