All patients will receive a preoperative multimodal analgesic regime:

• Tylenol® 975mg per os
• Naproxen® 500 mg per os

Patients will receive a spinal anesthetic with:

• Bupivacaine 0.5% 10 mg
• Fentanyl 10ug
• Epidural Morphine 150ug

After the spinal, a general anesthetic will be induced using:

• Midazolam 1 - 2 mg intravenously
• Fentanyl 1 - 2 ug/kg intravenously
• Propofol 1-3 mg/kg intravenously
• Rocuronium 0.3 - 0.9mg/kg intravenously
• followed by endotracheal intubation. Maintenance of anesthesia with sevoflurane, oxygen and air.
• Intraoperative Morphine 0 - 0.3mg/kg or Fentanyl 0 - 7.5ug/kg to maintain MAP and heart rate within 20% of baseline.
• Phenylephrine and Ephedrine can be used to support blood pressure and heart rate within 20% of baseline.
• Dexamethasone 4mg and Ondansetron 4mg intravenously
• Neostigmine 3mg and Glycopyrrolate 0.6mg intravenously Patients will receive a Morphine PCA to be initiated in the Post Anesthetic Care Unit (PACU).

The primary outcome will be total opioid use per day, as recorded by the PCA pump and transcribed by the nursing staff in the PACU and on the post-operative ward.

The primary outcome will be total opioid use per day, as recorded by the PCA pump and transcribed by the nursing staff in the PACU and on the post-operative ward.

The primary outcome will be total opioid use per day, as recorded by the PCA pump and transcribed by the nursing staff in the PACU and on the post-operative ward.