Epidural Analgesia Versus Opioid-sparing Analgesia for Open Ventral Hernia Repair With Transversus Abdominis Release

This study is comparing two ways to manage pain after a major hernia repair surgery called "transversus abdominis release." One method uses an epidural, a small tube placed in the back that delivers pain medicine directly around the spine. The other method avoids the epidural and instead uses a combination of non-opioid pain medicines, along with an injection of numbing medicine into the abdominal wall during surgery. Patients who still have pain that is hard to control with either method will be given rescue pain medicine through an intravenous (IV) pump. Researchers want to learn which method controls pain better and results in patients using fewer opioid pain medicines after surgery. Participants will be randomly assigned (like a coin flip) to one of the two pain control methods. Pain levels and medication use will be tracked during the hospital stay, and participants will be contacted 30 days after surgery to check on recovery and any side effects.

Inclusion Criteria: * Male or female patients ≥18 years old * Symptomatic incisional ventral or parastomal hernias * Planned transversus abdominis release * Ability to provide informed consent Exclusion Criteria: * Contraindications to epidural placement * Chronic pre-operative opioid use, defined as daily opioid use for 30-days prior to surgery * Allergy or intolerance to study medications * Age greater than 80 years * Impaired renal function - defined as creatinine clearance or estimated GFR of \