Page 9 - Clinical Connections - Spring 2023

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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