Author ORCID Identifier
0009-0009-6689-1487
0000-0002-0460-0754
0000-0001-7179-9196
Abstract
The Whipple’s procedure (pancreaticoduodenectomy), is a complex surgery performed for various indications, usually under general anesthesia (GA). However, GA carries a significant perioperative risk, especially in patients with comorbidities. Combined segmental spinal and epidural anesthesia (CSSE) with low doses of local anesthetics and adjuvants may be a feasible alternative owing to hemodynamic stability, potentially reducing complications and promoting enhanced recovery.
We present a 43-year-old male with periampullary adenoma with high-grade dysplasia who underwent a Whipple’s procedure under CSSE due to high-risk features (e.g., severe jaundice, low blood pressure, and anemia) and chronic smoking and alcoholism. Thoracic epidural (T7–T8) and spinal anesthesia (T8–T9) with bupivacaine and dexmedetomidine provided effective surgical anesthesia and hemodynamic stability. The procedure was successfully completed without conversion to GA, with early bowel recovery by postoperative day 1 and discharge on day 6.
CSSE resulted in safe, opioid-free anesthesia for a high-risk Whipple’s procedure, with enhanced recovery and a resource-sparing technique. Further studies are required to validate the role of CSSE in major oncologic surgeries.
Publication Date
2025
Publisher
JSS Academy of Higher Education & Research
Conflict of Interest
The author declares no conflicts of interest.
Keywords
Dexmedetomidine, enhanced recovery after surgery, epidural analgesia, obstructive jaundice, pancreaticoduodenectomy
Word Count
1030
Recommended Citation
Ravindran A, Khan IA, Paliwal NW.
Whipple’s Procedure Under Combined Segmental Spinal and Epidural Anesthesia with Enhanced Recovery: A Case Report.
Digital Journal of Clinical Medicine.
2025;
7(3):
-.
doi:
https://doi.org/10.55691/2582-3868.1258
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Cover Page Footnote
The manuscript represents valid work and that neither this manuscript nor one with substantially similar content under the present authorship has been published or is being considered for publication elsewhere and the authorship of this article will not be contested by anyone whose name (s) is/are not listed here. The order of authorships placed here is final and accepted by the co-authors.
Comments
The Whipple’s procedure (pancreaticoduodenectomy), is a complex surgery performed for various indications, usually under general anesthesia (GA). However, GA carries a significant perioperative risk, especially in patients with comorbidities. Combined segmental spinal and epidural anesthesia (CSSE) with low doses of local anesthetics and adjuvants may be a feasible alternative owing to hemodynamic stability, potentially reducing complications and promoting enhanced recovery. We present a 43-year-old male with periampullary adenoma with high-grade dysplasia who underwent a Whipple’s procedure under CSSE due to high-risk features