Submitted by:
Michelle S. Kars, MD, FAAP
North American Partners in Anesthesia

A 3 day-old full-term infant weighing 3.7 kg presents for thoracotomy for repair of esophageal atresia.  Echocardiogram reveals a small PFO.  Currently the infant is on nasal O2 with no pulmonary distress. Laboratory data is significant for INR of 1.4, and platelets of 60,000.  On discussion with the surgical and NICU teams, they would like to avoid prolonged intubation after surgery. Which of the following will provide thoracic dermatomal coverage and the longest duration block in order to minimize opioids and expedite extubation following surgery?