A U G U S T 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 7 3
• Shoulders. Dr. Tucker uses a beanbag positioner to place patients in a
slightly lateral position and ensures the beanbag doesn't press on the patient's
axilla. If patients are placed far lateral, says Dr. Tucker, make sure to position an
axillary positioning roll in a way that keeps pressure off the brachial plexus.
Also use a donut gel pad to make sure the head and neck are neutral. Confirm
that the ear is in the center of the donut, so it's not being crushed, and that the
pad is not pressing on the eye.
The patient's bottom arm should be placed out to the side. Position the elbow
slightly off the table's surface to keep weight off the axillary nerve. The peroneal
nerve in the lower leg is also vulnerable with the patient is the lateral position.
Place a pad between the patient's thigh to ensure the fibular head is free; you
should be able to slide your hand between the fibular head and the table to
ensure the peroneal nerve is free and clear.
Use a soft pad at the lateral anklebone to ensure bony prominences are well
padded. Place soft pillows between the patient's knees to keep them separated
and also use a pillow to keep the knees slightly bent, because pressure is placed
on the sciatic nerve or the hamstring if the knees straighten during the proce-
dure.
• Hips. Dr. Tucker approaches the hip joint laterally, so the positioning tech-
niques he uses are much the same as those for shoulder procedures. One major
difference: He uses a hip positioner to improve access to the joint and makes
sure the positioner's pads are positioned to support the anterior iliac spine, and
not pressing on the abdomen. When operating on heavier patients, he makes
sure the abdomen is well padded. Adipose tissue that's not ideally positioned
can compromise the surgeon's ability to approach the joint for maximum
access. When patients are placed in the lateral position, make sure men's scro-
tums aren't stuck between their legs and women's breasts are hanging free.
