Table 3. Pitfalls and pearls of the lateral decubitus position.

Pitfall	Pearls
Neurological injuries	• The safest traction method that would maximize visibility while minimizing strain to the nerves and detriment to the perfusion of the limb is the traction parallel to the long axis of the arm 26 with less than 12 lb. 21 in any of two positions: 45 degree of forward flexion and 90 degree of abduction or 45 degree of forward flexion and 0 degree of abduction. 59 • Another method of traction is the lateral traction to the mid-humerus perpendicular to the axis of the arm. While the risk of neurapraxia has been reported as inexistent with this method of traction, 10 there is a demonstrated detrimental effect in the perfusion of the arm from the constriction of the sling. 26 Therefore the use of a wide 4-in sling to decrease the tourniquet effect 26 with less than 7 lb. of weight traction to avoid strain to the nerves 21 is recommended. • When wrapping the traction system avoid direct pressure over bony prominences (wrist and elbow). • Additional care and counseling must be taken with patients with cervical ribs for the rare but possible risk of contralateral brachial plexus compression.
Airway obstruction	• Minimize arthroscopic pump pressures. • Use of deliberate hypotensive anesthesia in selected patients. • Limit the amount of irrigation fluid. • Restrict surgical time. • Longer cases should be performed under general anesthesia so that adequate control over airway is ensured.
Pressure-related injuries	• Pay attention to the detail in padding and positioning patients. • Check bony prominences, areola, and genitals for undue pressure zones. • Careful padding of contralateral arm and knees (special care to the lateral side of the dependent knee/common peroneal nerve). • Proper axillary roll position optimizes ventilation while preventing brachial plexus compression injury. 60 Axillary roll: not directly in the axilla. If possible, avoid the use of bags of fluids to make the axillary roll. • Carry out frequent evaluation of patient positioning and padding.