Parasternal Nerve Block in Cardiac Patients

Inclusion Criteria: * ≥ 18 years old * non-emergent coronary artery bypass grafting surgery (on and off pump) * median sternotomy 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.