Cardiac surgery is associated with significant postoperative pain, which complicates recovery. The unique aspects of cardiac surgical pain include multiple sites of pain, initial hemodynamic instability, and longer duration of acute postoperative recovery. Sources of pain include those directly related to surgery such as incisional pain, sternotomy, chest retraction, intercostal nerve pain, visceral pain, and leg pain from vein graft harvesting. There is also pain from operative positioning, which is worse for patients with preexisting back or limb issues. Postoperative sources of pain also include pain from the invasion of chest tubes, endotracheal tube, tracheal suctioning, urinary catheter, intravascular lines, nasogastric tube, and possibly postoperative pericarditis and pleuritis.