 Hello, I would like to thank the organizers of the 2022 perfusion conference at Texas Heart Institute for inviting me to speak. It is an honor and a pleasure to come. My name is Dr. Edward Yang. I am on staff at Baylor St. Luke's Medical Center at the Texas Heart Institute, and I will be speaking today on multimodal pain management as part of my address cardiac protocol challenges and strategies. Of course, ERS stands for enhanced recovery after surgery, and this is looking at specifically ERS in the cardiac surgical population. I have no disclosures to display. And we'll start by talking about the what is the problem that we're trying to address. The history of anesthesia for cardiac surgery has historically been a high opioid anesthetic initially with high dose morphine, 3 milligrams per kilo and muscle relaxants as the sole anesthetics. Subsequently, that has evolved into more purified forms of opioids fentanyl and sulfentanol, but again high dose opioids. In the 80s, then volatile and IV anesthetics have evidence of cardiac protection and opioid use has gradually been reduced into what we see today, which is low dose opioids. Cardiac surgery has a number of pain sources from the traditional sternotomies to the hemi sternotomies to even recently with the minimally invasive valve or bypass surgeries and thoracotomies. In addition, all the monitors, tubes and no.