Inclusion Criteria:  Participant provides consent to participate in study Ideal body weight (IBW) is >50kg Participant is planned to undergo coronary artery bypass graft or single valve repair/replacement surgery via median sternotomy Participant is undergoing an elective procedure  Exclusion Criteria:  Participant is unable or unwilling to give consent Non-English speaking Known or believed to be pregnant or is currently breastfeeding Participant is a prisoner Clinically unstable per discretion of the Investigator Participant requires urgent/emergent surgery History of previous sternotomy Preoperative coagulopathy (INR >1.4, platelets <100,000) or ongoing anticoagulation or anti-platelet therapy (except aspirin 81mg) Allergy or sensitivity to amide-type local anesthetics, dexmedetomidine or ketamine Participant has decompensated heart failure Severe left ventricle dysfunction (defined quantitatively as an ejection fraction of less than or equal to 35%) or right ventricle dysfunction (defined qualitatively as "severe") Diagnosis of cirrhosis or end-stage liver disease Requires the use of mechanical circulatory support pre-operatively Participant uses chronic opioids (meaning at the time of the preoperative screening evaluation by the study team, the patient is prescribed and taking any opioid pain medication)