Show Summary Details
Page of

Pain Management for Whipple Surgery 

Pain Management for Whipple Surgery
Pain Management for Whipple Surgery

Linh T. Nguyen

, and Jose M. Soliz

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2022. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 20 May 2022

This chapter addresses pain management in pancreatic cancer patients undergoing a Whipple procedure, in whom controlling pain is challenging in the presence of patient comorbidities such as liver cirrhosis, chronic kidney disease, and atrial fibrillation on anticoagulants. Most drugs are metabolized by the liver and excreted by the kidneys. A multimodal pain management approach can most effectively minimize the undesirable side effects of opioids. Peripheral nerve blocks and neuraxial blocks are excellent options. Traditionally, epidurals were commonly used for pain management for Whipple surgeries. However, transversus abdominis plane blocks have gained popularity partly with the increasing availability of portable ultrasounds, the lack of sympathectomy and resultant hypotension with the transversus abdominis plane (TAP) block, and the presence of contraindications to neuraxial anesthesia. The World Health Organization devised a 3-step ladder to guide physicians worldwide in the management of cancer pain, and this guide serves as an important conceptual framework for the treatment of chronic somatic, visceral, and neuropathic pain. The ladder is also useful for “step-down” analgesia in the perioperative period.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.