Get in the right "position" before the operation can begin

Author: Su Qingbin, deputy chief nurse, Zhongshan People's Hospital

Reviewer: Ruan Simei, Chief Nurse, Zhongshan People's Hospital

Many patients, especially those who are having surgery for the first time, often enter the operating room with a nervous and anxious mood. Some people will wonder: Should I lie down, lie prone, or sit for surgery? Some patients will ask before or after anesthesia: "Why do you have to take off all your clothes and put me in such a strange and awkward posture?" Why do some patients experience soreness, numbness, and skin damage after surgery? Next, let's talk about the "postures" in surgery, that is, surgical positions.

1. What is the surgical position?

The surgical position refers to the patient's lying position during the operation, which consists of the patient's lying posture, the position cushion and the use of the operating table. Generally, after anesthesia is completed and before the operation begins, the surgical staff including the surgeon, operating room nurse and anesthesiologist will jointly place the surgical position, and the patient does not need to make special preparations. Awake patients can follow the instructions of the surgical staff and try their best to cooperate.

2. Is it really so important to strike a good “posture”?

Getting the "posture" right is crucial for surgical treatment. Positioning the body is the first step in surgical operation. The success of any operation requires a clear and convenient surgical field of view for the doctor. The correct body position can obtain a good operating space, ensure patient safety, and shorten the operation time; otherwise, it can cause difficulties in surgical operation and even lead to serious consequences such as damage to important organs and heavy bleeding.

3. Are there any particular requirements for the surgical position?

The surgical position is performed by professionally trained medical staff, who need to conduct a detailed examination of the patient's body to ensure that the patient will not be harmed during the position placement process. At the same time, medical staff need to strictly abide by the surgical position placement principles, that is, the surgical area is fully exposed; ensure that the patient's breathing is unobstructed and the blood circulation is stable; maintain the normal physiological curvature and axis of the patient's body, maintain the limbs and joints in the physiological functional position, prevent excessive traction, twisting and vascular nerve damage; at the same time, pay attention to dispersing pressure, avoid local long-term pressure, and protect the integrity of the patient's skin; the position should be firmly fixed and the patient should be comfortable. In short, the surgical position placement must ensure the safety and comfort of the patient and reduce the occurrence of complications, and it must also be convenient for doctors to operate and shorten the operation time.

4. What are the common surgical positions? How should patients choose?

Common surgical positions in clinical practice include supine position, lateral position, prone position, lithotomy position and sitting position. With the development of medical technology and the implementation of various new surgical procedures, various "fancy positions" have gradually been extended, such as beach position, herringbone position, mermaid position, floating position, park bench position, etc., in combination with the location of the lesion and the needs of surgical operations. In general, the surgical position is determined by the location of the lesion and the surgical method. However, some special surgeries also need to fully consider the patient's body shape, the surgeon's preferences, etc. The optimal surgical position is determined by the surgeon based on various factors. The patient can prepare for the surgery with a relaxed attitude.

1. Supine position: The most common surgical position, suitable for surgeries on the head and neck, face, chest and abdomen, pelvis, limbs, etc.

Figure 1 Supine position (copyright image not authorized for reproduction)

2. Lateral position: Suitable for surgeries on the temporal, parietal, occipital, thoracic, lateral chest wall, waist, lateral thigh and hip, heel and other parts.

Figure 2 Lateral position (copyright image not authorized for reproduction)

3. Prone position: Suitable for surgeries on the occipital area, back of the neck, posterior spine, posterior pelvic area, dorsal side of limbs, etc.

Figure 3 Prone position (copyright image not authorized for reproduction)

4. Lithotomy position is suitable for perineal and abdominal perineal combined surgery.

Figure 4 Lithotomy position (copyright image not authorized for reproduction)

5. Sitting position is rarely used in clinical practice nowadays, and is mainly used for surgeries on the occipital area and back of the neck.

Figure 5 Seating (copyrighted images are not authorized for reproduction)

5. Will improper surgical position cause harm to the patient?

Improper surgical positioning does pose a risk of harm to the patient, but the probability of occurrence is very low, and serious consequences are extremely rare. Clinically, it is generally required that personnel involved in positioning must undergo professional training and pass the assessment, and must be experienced medical staff. Usually before positioning, the surgical staff will repeatedly confirm whether the position is correct and conduct a detailed full-body examination of the patient to ensure the patient's safety, take relevant preventive measures in advance, closely observe the patient's condition during the operation, and provide high-quality nursing services.

Of course, even with such strict management, factors such as forced posture, long operation time, patient's own condition and iatrogenic factors can still lead to complications such as pressure sores, muscle soreness, numbness of hands and feet, etc. However, the degree is generally mild and can be quickly restored to normal after treatment.

6. How to prevent postural complications?

The most common complication related to surgical position is pressure sore, followed by muscle and peripheral nerve injury. In a small number of patients, breathing and circulation changes may occur during surgery, which will be discovered and corrected by the surgical staff immediately.

Prevention is the main method to avoid the occurrence of pressure sores: ① Use the pressure sore risk assessment scale for graded management before surgery, formulate individualized preventive measures and focus on control for patients with medium and high risk of pressure sores; ② Use auxiliary soft pads to disperse pressure on protruding parts of compressed bony structures; ③ Keep the sheets clean and remove the patient's clothing when necessary to avoid shear force and reduce the risk of pressure sores; ④ Observe the skin condition of the patient's compressed area at any time during the operation and lift it up to reduce pressure regularly; ⑤ Keep the skin dry and keep warm.

The preventive measures for muscle and peripheral nerve injuries are mainly to maintain the normal physiological position of the limbs and avoid excessive stretching and continuous compression of the joints, muscles, and peripheral nerves.

7. How to deal with posture-related complications?

When local pressure ulcers occur after surgery, the pressure should be released immediately, and the local area should not be subjected to pressure again. Appropriate treatment should be given according to the grade of the pressure ulcer.

1. For stage 1-2 pressure ulcers (redness of the skin or blisters), keep the skin clean and dry and protect it with hydrocolloid or foam dressings.

2. For pressure ulcers of stage 3 (skin damage with visible subcutaneous tissue) and above, medical staff will use iodine tincture to disinfect the skin around the wound, then rinse with normal saline, perform wound debridement when necessary, and use appropriate dressings based on wound exudate and whether there is infection to promote wound healing.

Mild pain and paralysis caused by prolonged immobilization, compression, and traction will generally recover on their own within 3 to 5 days. If the symptoms are severe or there is no obvious improvement after surgery, you should report to the medical staff in time for treatment. Most muscle and nerve injuries caused by surgical positions can be recovered.

In short, getting the right posture is an essential step before surgery, which not only affects whether the surgery can go smoothly, but also affects the safety and comfort of the patient. The surgical staff will do their best to provide the patient with an optimal surgical posture to help every patient safely pass through the perioperative period.