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Pylorus-preserving pancreaticoduodenectomy" In surgical procedures that require a long time such as the Whipple procedure or Pylorus-preserving pancreaticoduodenectomy , the NeuroAxial approach is the choice because the patient does not have to recover consciously in the intensive room, postoperative pain management is also easier, our anesthesiologist team chooses a combination of continuous Thoraco epidural as high as T 7-8 levels and single Thoraco-Spinal shot as high as T8-9. Intrathecal adjuvants were given Dex-ket (10mcg-15mg), dexamethasone 4 mg. loading dose of Levo 7.5mg+Fentanyl 25mg via thoracoSpinal, Levo 5cc epidural as initial loading. The addition of the epidural drug was carried out after 3 hours as much as 5cc of levobupivacaine. additional sedation via CVC attached to the left subclavicle dex-ket 5mcg+15mg and midazolam 1mg, providing comfort with a ramsay score of 2-3. Pain management post operative is carried out through easypump 40cc levo + nacl0.9% + 10mg of midazolam dissolved in a total of 100cc, with a speed of administration of 2cc per hour. #anesthesiaexperts #anestesiUnpad #kmnUnhas #reliablepartner #pajunk #bbraunmedical #regionalanesthesia