Page 9 - Clinical Connections - Spring 2023
P. 9

Pain Clinic
        PAIN CLINIC FELINE CANCER CASE

        Thaleia-Rengina Stathopoulou, Lecturer in Anaesthesia and Analgesia, and Celia Figueroa Gonzalez,
        Senior Clinical Training Scholar in Oncology


              arry was an approximately 20-year-  It included meloxicam, for relief from the
              old  male  neutered  Bengal  cat.   neoplasia related inflammation, pregabalin,
        H He was diagnosed with an oral     aiming to alleviate the neuropathic pain,
        squamous cell carcinoma (SCC) involving   and  cannabidiol  (CBD)  for  additional  pain
        the left maxilla.  The tumour was invading   relief. He had also received buprenorphine
        the nasal cavity and the periorbital tissues,   sublingually,  a  partial  mu  opioid  proven
        making  surgical  excision  not  a  feasible   effective in various cases of oral pain.
        option.                               At presentation Harry was bright and alert
          Despite his age and diagnosis, Harry   and  soon became  everyone’s  favourite.
        was a lovely and active cat and maintained   His physical examination was normal, and
        a good quality of life. However, due to the   no one could believe his age. However, his
        location and the invasiveness of the tumour   body condition score was poor, revealing
        he was showing dysphagia and marked   the  chronic  effect  of  his  diagnosis.  He
        signs of pain.                      was reacting to gentle palpation of his left
                                            maxilla, and eye and as a sign of discomfort
        Palliative care strategy            he was trying to scratch the area repeatedly.
        His family looked for all the possible options   Left eye blepharospasm was also present.
        to make him happy for as long as possible
        without  prolonging  any  discomfort.  Taking   Nerve block use
        into consideration Harry's diagnosis, the   We  decided  with  his  family  that  the  best
        extensity  of  the  tumour,  and  the  relevant   option for him to maintain his quality of life
        prognosis,  Harry’s  family  decided  to   was to perform a neurolytic block under
        undergo palliative care, aiming to maintain   anaesthesia.  The aim of this nerve block
        his quality of life.                was to desensitise the nerve that was
          Just before Christmas, Harry and his   supplying  the  affected  area  temporarily,   Harry was able to enjoy a large meal in
                                                                                 recovery at the RVC
        family visited our Pain Clinic, following a   so he could keep enjoying his meals and
        consultation with the Oncology Service, to   time with his family.  The duration of this   Post discharge
        provide  further  analgesia  options.  He  was   intervention is reported to be two to three   Following  discharge,  he  spent  close  to
        already  receiving  a  multimodal  analgesia   months,  but  it  could  vary  due  to  the  local   two happy months with his family, during
        regime  that  included  various  groups  of   effect of the tumour.     which  he  was  comfortable and  energetic
        medications for treating pain, aiming to   Harry  underwent general anaesthesia   as before. Unfortunately, during this time,
        reduce side effects and treat pain through   and we tried to identify the infraorbital canal   he experienced bleeding episodes that
        different cellular pathways.        to perform the nerve block.  As expected,   were more than likely associated with the
                                            the area over the left maxilla was thickened   progression of  the  disease.  After  the  last
                                            and  anatomically  distorted.  Aided  by  a   episode, it was decided that the best for him
                                            previous CT scan, we were able to identify   would be to be euthanised, accompanied by
                                            the location of the canal and dispense   his family.
                                            the injectate accurately, using ultrasound   Despite the outcome, Harry remained a
                                            to guide our needle. Initially we injected   happy boy even up to a few hours before
                                            lidocaine to provide a local analgesia effect,   the final bleeding episode, and he managed
                                            followed by a small volume of ethanol 70%   to celebrate Christmas and his birthday with
                                            and buprenorphine.                  his beloved family.
                                              After his short anaesthetic, Harry   This case is an excellent illustration that
                                            recovered uneventfully, and he received   there  are  still  options  to  maintain  a  good
                                            an infusion of bisphosphonates (zoledronic   quality of life, despite age and diagnosis.
                                            acid) to decrease the cancer-related pain   The combination of his committed and
                                            due  to  osteolysis.  We  were  extremely   understanding family alongside strong
                                            pleased to see Harry eating a large meal   teamwork  between  the  Pain  Clinic  and
                                            and treats. He was everyone’s favourite   Oncology made the success of this case
         Harry within the Oncology Service   story for Christmas.               possible.


                                                                                      For small animal referrals, please call:
                                                                                     01707 666399
                                                                                      Email:
                                                                                     qmhreception@rvc.ac.uk


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