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Pain Management for Whipple Surgery 

Pain Management for Whipple Surgery
Chapter:
Pain Management for Whipple Surgery
Author(s):

Linh T. Nguyen

, and Jose M. Soliz

DOI:
10.1093/med/9780190856649.003.0010
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date: 20 September 2019

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.

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