Regional Anesthesia in Minimally Invasive Lumbar Spine Surgery

Inclusion Criteria:

* Age 18-80
* Undergoing one of 3 procedure types: 1) 2 or more levels of MIS decompression (e.g., discectomy, foraminotomy, laminectomy); 2) 1-3 levels of MIS transforaminal lumbar interbody fusion (TLIF) (with or without additional levels of MIS decompression for no greater than 3 total operative levels); 3) 1-3 levels of anterior lumbar interbody fusion (ALIF) or MIS lateral lumbar interbody fusion (LLIF) accompanied by posterior percutaneous instrumentation at the same levels
* Willing and able to give consent

Exclusion Criteria:

* Opioid tolerant at the time of the surgical procedure--defined as consuming greater than 30mg of morphine milligram equivalents (MME) daily (https://www.cdc.gov/drugoverdose/prescribing/guideline.html)
* Presence of an indwelling pain device (e.g., intrathecal opioid pump, spinal cord stimulator, dorsal root ganglion stimulator)
* Known allergy to bupivacaine, clonidine or similar local anesthetics
* Indication for surgery other than degenerative disease (e.g., neoplasm, infection, trauma)
* Chronic kidney disease (stage 3 or greater), or hepatic failure
* Active pregnancy
* Disease process or mental illness that would preclude accurate evaluation of pain in the perioperative period
* Active Worker's Compensation litigation