Georgiou S.G. DVM, MSc in Algology, PhD in Veterinary Anaesthesia, Volos Veterinary Specialists, Volos | Diamantis F. DVM, MSc Surgery, SASTS (SCIVAC), Volos Veterinary Specialists, Volos | Koutina F.A. DVM, GpCert Internal Medicine (candidate), Volos Veterinary Specialists, Volos | Milini T.K. DVM, GpCert Internal Medicine (candidate), Volos Veterinary Specialists, Volos | Papagiorgou E. DVM, GpCert Emergency Medicine and Surgery (candidate), Volos Veterinary Specialists, Volos | Galatos A.D. DVM, PhD, Dipl ECVAA, EVS (in anaesthesia), Professor of animal surgery & anaesthesia, Clinic of Surgery, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
Introduction
Postamputation pain has been classified as severe to excruciating whereas the potential development of chronic pain with a neuropathic component, remains a major concern.
Opioids are the cornerstone of acute postoperative pain management; however opioid free or opioid-sparing approaches have been used due to opioid well-established side-effects. In the context of cancer patients, surgical stress, opioids and even inhalant anaesthetics have been associated with a potential negative impact on tumor recurrence, distal metastasis and long-term survival in humans.
Clinical case
We present the perianaesthetic management of a front limb amputation in an 8-year-old male neutered cat with fibrosarcoma, using a multimodal opioid-sparing approach. Dexmedetomidine, midazolam and buprenorphine were administered for premedication, whereas induction and maintenance of anaesthesia was achieved with propofol. Additionally, a constant rate infusion of ketamine and magnesium sulfate, regional ropivacaine infusion through a wound infusion catheter, meloxicam and pregabalin were administered throughout the perioperative period. Postoperative pain was assessed with UFEPS-SF and Feline Grimace Pain scales, while serial measurements of serum magnesium concentrations were carried out up to 36 hours postoperatively.
Results
Intraoperative and postoperative periods were uneventful, no rescue analgesia was required, and the cat was discharged 4 days later. 1.5 year later, the cat is asymptomatic without signs of cancer recurrence.
Conclusions
This opioid-sparing approach contributed to intraoperative haemodynamic stability and an acceptable analgesic outcome, despite minimum opioid utilization.
