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B247 Madelung´s disease and regional anaesthesia´s true role – a case report
  1. P Camoes Correia,
  2. P Marques and
  3. AL Veiga de Macedo
  1. Centro Hospital Universitário Coimbra, Coimbra, Portugal


Background and Aims Madelung´s disease is a rare condition, characterized by painless, diffusely distributed, non- encapsulated subcutaneous deposits (1)

Methods A 47-year-old male, proposed for a right inguinal hernioplasty on an outpatient basis. With a personal background of Madelung’s disease, painless lipomatous masses in the cervicofacial region and in the upper regions of the trunk, hypertension, and chronic alcohol habits. Evaluation of the airway showed limited cervical extension, lipomatous deposits around mouth, incomplete denture and an IV on the Mallampati scale.

A standard ASA monitoring was performed, O2 was placed under nasal cannulas at 3l/min, droperidol 0.625mg and fentanyl 0.05mg IV were administered. Subarachnoid spinal block was performed, between L3-L4, with Levobupivacaine 12.5mg and Sufentanil 2.5 mcg, positioned in left lateral decubitus.

Results After confirmation of block installation, the surgical procedure began lasting 45 min. Following the end of surgery, an ilioinguinal and right iliohypogastric block was performed, under ultrasound guidance without intercurrences. Patient´s was transferred to the PACU, with paracetamol and opioid IV analgesia. The reversal of motor block occurred 2 hours after it was performed. The stay at PACU was uneventful, and the patient was discharged 6 hours after the surgical procedure with the criteria for outpatient surgery met.

Conclusions This case report shows a patient with a possible difficult airway presentation for ventilation and intubation (2). For these reasons regional anaesthesia should be considered on patients with Madelung´s disease avoiding airway manipulation, decreasing the risk of complications, and allowing for an early discharge on outpatient surgeries.

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