Epidural analgesia provides safe and effective pain management after thoracic and abdominal surgery. In this study, the efficacy of epidural analgesia for postoperative pain management and its affects on the postoperative course were compared to intravenous morphine patient-controlled analgesia (PCA) for patients undergoing transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. A review of records of 10 TRAM flap patients managed with epidural analgesia and 10 TRAM flap patients managed with morphine PCA from January 2002 to August 2002 was conducted. Time to oral intake, flatus, ambulation, duration of hospitalization, and postoperative pain control (reported on a 10 point scale) were determined. Medication side effects, including nausea and vomiting, hypotension, and pruritis were also compared. Patients with epidural analgesia reported significantly lower pain levels compared to morphine PCA. Duration of hospitalization averaged 88 hours for both groups. No significant differences in time to ambulation, time to flatus, or time to oral intake were seen. Medication side effects were mild and of similar frequency among the groups. This study confirms that epidural analgesia can improve postoperative pain management for TRAM flap patients without substantially altering other aspects of the postoperative course.