This study evaluates a modified lateral decubitus positioning method designed to prevent pressure injuries and reduce shoulder traction pain in patients undergoing neurosurgical procedures under general anesthesia. Participants will be randomly assigned to either the modified positioning group or the conventional positioning group. The main goal is to compare the incidence of Stage I pressure injuries (per NPUAP criteria) at the end of surgery and the severity of shoulder pain (measured by VAS) at 24 hours postoperatively. Secondary outcomes include positioning time, healthcare worker satisfaction, and changes in CORN intraoperative pressure injury risk scores. This research aims to provide evidence-based guidance for optimizing intraoperative nursing care and improving patient safety and comfort in the operating room.
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)
Pre-existing skin injury before surgery
Acute or chronic skin disease
Communication disorder / inability to express pain verbally
Severe cardiac, hepatic, or renal disease
Parallel
Modified Lateral Decubitus Positioning Protocol
Procedure/SurgeryPatients receive a modified lateral decubitus 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 during neurosurgical procedures under general anesthesia. Positioning is performed after induction of anesthesia and before surgical incision.
Conventional Lateral Decubitus Positioning
Procedure/SurgeryPatients receive the standard traditional lateral decubitus positioning method routinely used in clinical practice, including axillary rolls, manual shoulder taping, and sequential placement of support pads. No specialized arm board or adhesive fixation is used.
Incidence of skin redness (blanching erythema) at end of surgery
Number (%) of participants with pressure-induced skin redness (defined as blanching on 3-second fingertip pressure) at dependent sites (sacrum, ASIS, external malleolus, axilla, rib margin, lateral knee) assessed by trained researcher at operative end.
Incidence of Stage I pressure injury (NPUAP) at end of surgery
Number (%) per NPUAP staging
Shoulder traction pain VAS at 24 h postop
Visual analogue scale(VAS) 0-10 (0 none, 1-3 mild, 4-6 moderate, 7-10 severe); reported as median (Q1, Q3)
Positioning time (minutes)
From command "turn" to circulating nurse sign-off; mean ± SD
Healthcare worker satisfaction with positioning method
3-level scale (very satisfied / satisfied / unsatisfied) for surgeons, anesthesiologists, circulating nurses; reported as count (%)
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