Patient Controlled Epidural Analgesia Versus Intravenous Patient Controlled Analgesia for Post-Operative Pain Control in Patients Undergoing Elective Liver Resection

Exclusion Criteria

• •Patients with a history of documented anaphylaxis or contraindication to any of the study medications or standardized intra-operative medications. These include dilaudid, fentanyl, and bupivacaine.
• •Patients with pain at rest or with movement measured by NRS \>2.
• •Patients receiving high dose opioids on a chronic basis (greater than or equivalent to 60mg of morphine per day).
• •Patients with severe chronic obstructive pulmonary disease (COPD) defined as an FEV1 \<50%.
• •Patients with significant cognitive impairment or documented psychologic impairment.
• •Contraindication to epidural catheter placement including bleeding diathesis (essential thrombocythemia, idiopathic thrombocytopenic purpura, von Willebrand disease, and hemophilia A or B), neurological dysfunction (multiple sclerosis, subacute myelo-opticoneuropathy or preexisting lower limb neurological deficit), prior extensive spinal surgery or major spinal deformity, pre-operative use of anti-coagulant with planned use of therapeutic dose of anti-coagulant in post-operatively, documented pre-operative coagulopathy (INR greater than 1.3 not on Coumadin or PTT greater than 42), platelets less than 100,000/μL, or evidence of infection at potential epidural site.
• •Cirrhotic patients. When incidentally discovered intra-operatively, patients will be excluded from the study and replaced, but will be followed for primary and secondary endpoints.
• •Patients with poor performance status preoperatively such that they are unable to walk up two flights of stairs.
• •Patients taking any opioid agonist/antagonist medication (i.e. Buprenorphine)