Bilateral Transversus Abdominis Plane Block With Exparel Verus Continuous Epidural Analgesia With Bupivacaine

The investigator goal is to compare the analgesic efficacy of TAP blocks with liposomal
bupivacaine (Exparel) and continuous epidural blocks in patients who are scheduled for major
lower abdominal surgery. To assess whether TAP block with Exparel is noninferior to
continuous epidural analgesia on pain management, defined as noninferior for both pain
control and total opioid consumption for 72 hours, in patients who had major lower abdominal
surgery.

Inclusion Criteria:

- Written informed consent

- 18-85 years old

- ASA Physical Status 1-3

- Scheduled for elective open or laparoscopic abdominal surgery, including colorectal
and hysterectomy surgeries

- Anticipated hospitalization of three nights

- Expected requirement for parenteral opioids for at least 72 hours for postoperative
pain

- Able to use IV PCA systems.

Exclusion Criteria:

- Hepatic disease, e.g. twice the normal levels of liver enzymes

- Kidney disease, e.g. twice the normal level of serum creatinine

- Bupivacaine sensitivity or known allergy

- Women who are pregnant or breastfeeding

- Anticoagulants considered to be a contraindication for epidural or TAP blocks.

- Surgeries with high port sites will be excluded