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 theDepartment of Anesthesiology and Perioperative Medicine, General Hospital of NingxiaMedical University. The study aims to evaluate the efficacy of a modified lateraldecubitus positioning protocol in reducing intraoperative pressure injuries andpostoperative shoulder traction pain among patients undergoing elective neurosurgicalprocedures under general anesthesia.Study Design and Masking:Patients are randomly assigned to either the experimental group (modified positioningprotocol) or the control group (conventional positioning protocol). Participants areblinded to their group allocation, as all positioning procedures are performed after theinduction of general anesthesia and before surgical incision. However, due to the natureof the procedural intervention, operating room staff (care providers) and outcomeassessors cannot be blinded to the group allocation.Interventions:Experimental Group: Patients receive a modified positioning protocol utilizing anL‐shaped one‐piece arm board for dependent arm suspension and a funnel‐shaped adhesivefilm for shoulder fixation at a 45‐degree angle. This approach aims to optimize pressureredistribution and reduce nerve traction.Control Group: Patients receive the standard traditional lateral decubitus positioningmethod routinely used in clinical practice, involving axillary rolls, manual shouldertaping, and sequential placement of support pads.Procedures and Assessments:Upon obtaining informed consent, baseline data including the CORN (Chinese Operating RoomNurse) intraoperative pressure injury risk score are collected. During the procedure,positioning time is recorded from the command to turn the patient to the circulatingnurse's final confirmation. Postoperatively, the incidence of skin erythema and Stage Ipressure injuries (assessed via NPUAP criteria) is documented. Shoulder traction pain isevaluated 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 thatenhances patient safety and comfort while improving workflow efficiency for the surgicalteam.