Goich Mariela, Bascuñán Alejandra, Faúndez Patricio, Valdés Alicia
Escuela de Medicina Veterinaria, Facultad de Ciencias de la vida, Universidad Andres Bello.
University of Chile, Veterinary Hospital.
JFMS Open Rep. 2019 Jun 18;5(1):2055116919855809. doi: 10.1177/2055116919855809. eCollection 2019 Jan-Jun.
A 2-year-old polytraumatized male cat was admitted to a teaching hospital for correction of a defective inguinal herniorrhaphy. Upon arrival, the cat showed signs of neuropathic pain, including allodynia and hyperalgesia. Analgesic therapy was initiated with methadone and metamizole; however, 24 h later, the signs of pain continued. Reparative surgery was performed, and a multimodal analgesic regimen was administered (methadone, ketamine, wound catheter and epidural anesthesia). Postoperatively, the cat showed signs of severe pain, assessed using the UNESP-Botucatu multidimensional composite pain scale. Rescue analgesia was initiated, which included methadone, bupivacaine (subcutaneous wound-diffusion catheter) and transversus abdominis plane block. Because the response was incomplete, co-adjuvant therapy (pregabalin and electroacupuncture) was then implemented. Fourteen days after admission, the patient was discharged with oral tramadol and pregabalin for at-home treatment.
Neuropathic pain is caused by a primary lesion or dysfunction in the nervous system and is a well-described complication following trauma, surgical procedures such as hernia repair, and inadequate analgesia. The aims of this report are to: (1) describe a presentation of neuropathic pain to highlight the recognition of clinical signs such as allodynia and hyperalgesia in cats; and (2) describe treatment of multi-origin, severe, long-standing, 'mixed' pain (acute inflammatory with a neuropathic component). The patient was managed using multiple analgesic strategies (multimodal analgesia), including opioids, non-steroidal anti-inflammatory drugs, locoregional anesthesia, co-adjuvant drugs and non-pharmacological therapy (electroacupuncture).
一只2岁的多发伤雄性猫被送往一家教学医院，以纠正有缺陷的腹股沟疝修补术。入院时，这只猫表现出神经性疼痛的症状，包括痛觉过敏和痛觉超敏。开始使用美沙酮和安乃近进行镇痛治疗；然而，24小时后，疼痛症状仍持续存在。进行了修复手术，并给予了多模式镇痛方案（美沙酮、氯胺酮、伤口导管和硬膜外麻醉）。术后，这只猫表现出严重疼痛的症状，使用圣保罗大学-博图卡图多维综合疼痛量表进行评估。开始进行救援镇痛，包括美沙酮、布比卡因（皮下伤口扩散导管）和腹横肌平面阻滞。由于反应不完全，随后实施了辅助治疗（普瑞巴林和电针疗法）。入院14天后，患者出院，带口服曲马多和普瑞巴林进行居家治疗。
神经性疼痛由神经系统的原发性病变或功能障碍引起，是创伤、疝修补等外科手术以及镇痛不足后一种广为人知的并发症。本报告的目的是：（1）描述神经性疼痛的表现，以突出对猫痛觉过敏和痛觉超敏等临床症状的识别；（2）描述对多源性、严重、长期的“混合”疼痛（伴有神经性成分的急性炎症性疼痛）的治疗。该患者采用了多种镇痛策略（多模式镇痛）进行管理，包括阿片类药物、非甾体抗炎药、局部区域麻醉、辅助药物和非药物治疗（电针疗法）。
