Abstract Background Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. Aim of the Work The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital. Results Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control. Conclusion Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics.