Inclusion Criteria:  Transgender persons 18 years and older Undergoing gender affirming surgeries performed by either Dr. Maurice Garcia (orchiectomy only, vaginoplasty with or without canal & orchiectomy, colon-vaginoplasty, & peritoneal vaginoplasty; Stage I phalloplasty, or stage II phalloplasty); Dr. Edward Ray (feminizing chest surgery, masculinizing chest surgery, stage I phalloplasty); Dr. Amit Gupta (orchiectomy and peritoneal vaginoplasty only); or Dr. Yosef Nasseri (colon vaginoplasty surgery)  Exclusion Criteria:  Patients who do not meet the inclusion criteria above Any contraindications to the study drugs. Patients with neurologic deficits that preclude them from sensing pain. Patients with implanted pain neuromodulator devices (e.g., neurostimulator) Patients who do not speak English