Background
The commonly described technique for positioning the non-operative arm for upper limb surgery in the lateral decubitus position (LDP) is that of 90° of forward flexion at the shoulder and 90° of flexion at the elbow with the forearm pointing towards the head end.1,2 Our novel technique uses an arm sling to safely position the non-operative arm, allowing unhindered anaesthetic access at no additional cost to the procedure.
Technique
The anaesthetised patient is positioned in the LDP with the operative arm (upper arm) held in position using well padded posts. A single use, universal size arm sling (Össur, Reykjavik, Iceland) is used to support the non-operative forearm (lower arm). The sling’s shoulder strap is passed across the body, through the cuff end of the sling, and fastened to the opposite side attachment of the operating table (Figures 1–3). The elbow can be flexed up to 90° and the forearm rests comfortably over the chest with the strap holding the limb in this position throughout the procedure.
Figure 1.
Photograph of the patient in the lateral decubitus position for right upper limb surgery showing the left arm with monitoring attachments and intravenous access, supported in the arm sling and positioned over the chest
Figure 2.
Close-up photograph of the non-operative limb supported in the sling showing an intravenous port with unrestricted access for the anaesthetist
Figure 3.
Photograph showing the shoulder strap of the sling fastened securely to the operative table on the posterior side of the patient
Discussion
Peripheral nerve injuries are well documented complications of perioperative malpositioning of the operative and non-operative limb.3 Abduction, external rotation and extension of the arm can result in brachial plexus injury.4 Our technique avoids any traction or pressure to neurovascular structures by keeping the arm in a natural resting position. It does not interfere with intraoperative fluoroscopy, and also provides constant access for the anaesthetist to monitor intravenous cannula patency, pulse oximetry and blood pressure. After the procedure, the same sling can be re-used for supporting the operative arm for the same patient.
References
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