Background Thoracic epidural analgesia (TEA) is widely regarded as the gold standard for postoperative pain control in patients undergoing abdominal surgery. While its benefits over systemic opioids and other analgesic modalities are well-documented, gaps remain in existing literature regarding outcome stratification based on modifiable factors of TEA. This study aimed to evaluate the effectiveness of TEA for postoperative pain control and assess how modifiable factors influence pain scores and opioid use after abdominal surgery. Methods Approval was obtained from the Saint Louis University Institutional Review Board to conduct this single-center retrospective chart review. Records were identified for a total of 176 adult patients who underwent abdominal surgery and received preoperative placement of a thoracic epidural between 2020 and 2022. Data on patient demographic information, procedural information regarding epidural placement, and post-surgical outcomes were collected through review of the electronic medical record system. Primary outcomes included patient-reported pain scores and adjunct opioid usage. Data were analyzed using t-tests, one-way ANOVA, and simple linear regression. Results Patients who did not require initiation of patient-controlled analgesia (PCA) postoperatively, indicating a successful epidural, reported significantly lower pain scores during epidural use (p = 0.009) and required significantly less adjunct opioids (total MME: p < 0.001; average daily MME: p = 0.003). Administering epidural bupivacaine alone, compared with hydromorphone + bupivacaine, was associated with significantly higher pain scores at 24 hours, during the epidural period, and over the length of hospital stay (p = 0.014, 0.021, 0.023, respectively). Epidurals placed at T9–T10, compared with those placed at T12-L1, were associated with significantly lower pain scores at the three time points studied (p = 0.019, 0.009, 0.008), as well as lower daily adjunct opioid use (p = 0.046). Conclusion TEA is effective in controlling postoperative pain and reducing opioid consumption following abdominal surgery. The combination of a local anesthetic with an opioid, particularly hydromorphone, yields better analgesic outcomes than local anesthetic alone. Additionally, higher thoracic placement levels, especially T9–T10, are associated with improved pain control, underscoring the importance of accurate catheter placement. These findings highlight modifiable factors that can enhance TEA efficacy and inform future initiatives to optimize perioperative pain management.