Clinical Trials

Inclusion Criteria:

• Age > 18 and ≤ 80 years old.
• Elective surgery for suspected (based on consulting surgeon’s opinion - imaging, lab, path) gynecological malignancy, ERAS protocol.

Exclusion Criteria:

• Inability to read or understand English.
• Prehospitalization narcotic use if weekly average daily oral morphine equivalent of > 20 mg.
• Chronic pain syndromes such as fibromyalgia.
• Extensive surgery planned (surrogate for postop pain):
  • Planned ICU admission, abdominoperineal resection, exenteration, use of IORT, HIPEC.
• Contraindication to neuraxial analgesia:
  • Coagulopathy:
    • INR >1.2 Current or predicted after surgery (e.g., planned right hepatic resection);
    • Thrombocytopenia (plts < 100);
    • Hemophiliac disease states (hemophilia, von Willebrand disease, etc.);
    • Patients receiving antithrombotic or thrombolytic therapy are excluded according to the ASRA guidelines (Reference: https://rapm.bmj.com/content/rapm/43/3/263.full.pdf).
  • Localized infection at the potential site of injection.
  • Significant developmental or structural spinal abnormalities that would preclude a safe spinal technique. These include spina bifida, tethered spinal cord, lumbar spinal fusion, and active lumbar radiculopathy.
• Patients with stage 4 or 5 kidney disease (GFR less than 30 ml/min per 1.73 m^2).
• Intolerance or allergy to opioids, acetaminophen, or amide-type local anesthetics.
• Current pregnancy.