• Pre and intraoperative analgesic consumption in fentanyl equivalents [ Time Frame: 3 and 6 months post-operatively ] [ Designated as safety issue: No ]
• Time from end of surgery to readiness for hospital discharge. [ Time Frame: number of days to hospital discharge ] [ Designated as safety issue: No ]
• Verbal response pain scores [ Time Frame: PACU admission and discharge,first and second postoperative mornings. ] [ Designated as safety issue: No ]
• Incidence of postoperative nausea [ Time Frame: Day 1 and day 2 post-operatively ] [ Designated as safety issue: No ]

The investigators are conducting this study to find out if intravenous (injected through the vein) infusion of lidocaine and ketamine administered with general anesthesia is as effective as a paravertebral block in lessening pain after surgery and that both of these techniques are superior to general anesthesia alone in reducing pain immediately after surgery and in the long-term.

Participants will be randomized into one of three study groups; Group 1 - Paravertebral Group - ropivacaine is injected near the spine before surgery. Midazolam and fentanyl are administered intravenously for sedation. Group 2 - Lidocaine/Ketamine - General anesthesia with lidocaine and ketamine administered intravenously throughout your surgery and for 60 minutes after surgery. Group 3 - General Anesthesia Alone. General anesthesia with placebo administered intravenously throughout surgery and for 60 minutes after surgery. All participants will rate their pain on a scale from 0 to 10 after surgery and on days 1 and 2 after surgery. Participants are called 3 and 6 months after surgery for pain and quality of life assessments

• Pain
• Nausea

• Drug: ropivacaine
• Drug: Lidocaine/Ketamine
• Other: placebo

• Active Comparator: Paravertebral Group - A local anesthetic (ropivacaine) will be injected near the spine before surgery. Participants will also receive midazolam and fentanyl intravenously (through your vein) for sedation
• Active Comparator: Participant will receive general anesthesia through the vein before surgery. Lidocaine and ketamine will be administered intravenously throughout surgery and for 60 minutes after surgery.
• Placebo Comparator: General anesthesia plus placebo. Placebo will be administered intravenously until 60 minutes after surgery

Inclusion Criteria:

• Age greater than 18 and less than 75 years
• Unilateral inguinal hernia scheduled for elective open repair

Exclusion Criteria:

• Incarcerated hernia or urgent procedure
• Reoperation (recurrent hernia)
• Contraindication to regional anesthesia such as:
• Coagulopathy
• Infection at the site of needle insertion
• Pre-existing chronic pain (at any site) requiring treatment
• Contraindication to any study medication (local anesthetic or ketamine)
• History of significant Axis I psychiatric disease (major depressive disorder,bipolar disorder, schizophrenia, etc.)
• Significant hepatic (ALT or AST > 2 times normal) or renal (serum creatinine > 2 mg/dl) impairment