Regional Nerve Blocks

Inclusion Criteria:
*  Are 65 or older
*  Indicated for lumbar spinal fusion of less than or equal to 3 levels
*  Undergoing elective surgery
*  no contraindications to local anesthetic or procedures
*  no severe cardiac or respiratory disease
*  no preexisting cognitive dysfunction/dementia

Exclusion Criteria:
*  64 years old and younger
*  emergency treatment
*  pathologic fractures
*  seeking revision surgery
*  major liver or kidney dysfunction
*  coexisting hematological disorder or irreversible abnormal coagulation
*  patients with previous diagnosis of dementia or SLUMS score \<20
*  patient unable to communicate/cooperate/language barrier
*  BMI\>40
*  allergy to study medications
*  opioid tolerant (oral opioid intake morphine equivalent =\< 60 mg/day)
*  other sources of chronic pain like fibromyalgia
*  patients with associated significant CNS or respiratory disease (home oxygen requirements)
*  incarcerated patients
*  psychiatric illnesses preoperative neurological deficits greater than one motor group, less than three out of five motor functions
*  pregnant or breast feeding