Inclusion Criteria:  Scheduled cardiac surgery patients Complete median sternotomy Adult (19 years old or older) English-speaking  Exclusion Criteria:  Preoperative Exclusion Criteria:  Patient refusal Emergent surgery Inability to provide consent Inability to follow up via telephone Known preoperative coagulopathy i) Congenital coagulopathy ii) Congenital platelet disorders iii) Platelet count < 50 x 109 iv) International normalized ratio (INR) or activated partial thromboplastin time (aPTT) exceeding the upper range of normal in the absence of anticoagulant use v) Does not include active anticoagulant or antiplatelet use Predicted post-operative therapeutic anticoagulation within 48 hours. Skin disease over block insertion site that would prevent catheter securement Immunodeficiency including uncontrolled diabetes, as defined by HbA1C more than 8.5% (20) Preoperative advanced liver failure (as defined by Child-Pugh B or C) (21) Preoperative advanced renal failure (as defined by Estimated Glomerular Filtration Rate (eGFR) < 30 mL/min/1.73 m2) Opioid tolerance (as defined by morphine oral equivalent >60mg for a period of 7 days or longer pre-operatively) (22) Allergy to local anesthetic, acetaminophen, or hydromorphone Weight less than 60 kg  Postoperative Exclusion Criteria:  Postoperative bleeding at time of randomization as defined by initial chest tube loss of >350 mL, >200 mL per hour loss, > 2 mL/kg/hour loss for 2 consecutive hours, or requiring return to the operating room for surgical management (23) Hemodynamic instability, as determined by CSICU attending anesthesiologist Anticipated mechanical ventilation of more than 24 hours Anesthesiologist unavailable to insert PIFB catheter within 4 hours of CSICU arrival