Effect of Positioning Protocol on Skin Pressure Injury and Shoulder Traction Pain in Neurosurgical Patients

This is a randomized, single-blind, parallel-group controlled trial conducted at the Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University. The study aims to evaluate the efficacy of a modified lateral decubitus positioning protocol in reducing intraoperative pressure injuries and postoperative shoulder traction pain among patients undergoing elective neurosurgical procedures under general anesthesia.

Study Design and Masking:

Patients are randomly assigned to either the experimental group (modified positioning protocol) or the control group (conventional positioning protocol). Participants are blinded to their group allocation, as all positioning procedures are performed after the induction of general anesthesia and before surgical incision. However, due to the nature of the procedural intervention, operating room staff (care providers) and outcome assessors cannot be blinded to the group allocation.

Interventions:

Experimental Group: Patients receive a modified positioning protocol utilizing an L-shaped one-piece arm board for dependent arm suspension and a funnel-shaped adhesive film for shoulder fixation at a 45-degree angle. This approach aims to optimize pressure redistribution and reduce nerve traction.

Control Group: Patients receive the standard traditional lateral decubitus positioning method routinely used in clinical practice, involving axillary rolls, manual shoulder taping, and sequential placement of support pads.

Procedures and Assessments:

Upon obtaining informed consent, baseline data including the CORN (Chinese Operating Room Nurse) intraoperative pressure injury risk score are collected. During the procedure, positioning time is recorded from the command to turn the patient to the circulating nurse's final confirmation. Postoperatively, the incidence of skin erythema and Stage I pressure injuries (assessed via NPUAP criteria) is documented. Shoulder traction pain is evaluated at 24 hours postoperatively using the Visual Analog Scale (VAS). Additionally, satisfaction levels regarding the positioning method are surveyed among surgeons, anesthesiologists, and circulating nurses.

Objective:

This study seeks to establish an evidence-based, ergonomic positioning standard that enhances patient safety and comfort while improving workflow efficiency for the surgical team.

Inclusion criteria

• Age ≥ 18 years
• Elective neurosurgical procedure under general anesthesia
• Planned surgical position: lateral decubitus
• Expected operative duration ≥ 2 hours (from completion of positioning to end of surgery)

Exclusion criteria

• Pre-existing skin injury before surgery
• Acute or chronic skin disease
• Communication disorder / inability to express pain verbally
• Severe cardiac, hepatic, or renal disease

Withdrawal Criteria:

• Intraoperative change of surgical position from lateral decubitus to another position due to unexpected surgical requirements
• Intraoperative hemodynamic instability or other critical events requiring immediate repositioning or termination of the procedure
• Inability to complete the 24-hour postoperative follow-up assessment (e.g., transfer to ICU, unplanned reoperation, or death)
• Development of a serious adverse event directly attributable to the positioning procedure that necessitates discontinuation of the assigned protocol