Liposomal Bupivacaine With or Without Hydromorphone for the Improvement of Pain Control After Laparotomy in Patients With Gynecological Malignancies

Inclusion Criteria: * Elective surgery for suspected (based on consulting surgeon's opinion-imaging, laboratory \[lab\], pathology \[path\]) gynecological malignancy, enhanced recovery after surgery (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 post-operative \[postop\] pain): Planned intensive care unit (ICU) admission, abdominoperineal resection, exenteration, use of intraoperative radiation (IORT), hyperthermic intraperitoneal chemotherapy (HIPEC) * Contraindication to neuraxial analgesia: * Coagulopathy * International normalized ratio (INR) \> 1.2 current or predicted after surgery (e.g. planned right hepatic resection) * Thrombocytopenia. Platelets (plts) \< 100 * Hemophiliac disease states (hemophilia, von Willebrand disease, etc.) * Patients receiving antithrombotic or thrombolytic therapy are excluded according to the American Society of Regional Anesthesia and Pain Medicine (ASRA) guidelines * 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 (glomerular filtration rate \…