Positioning-related nerve injuries remain a concern across surgical specialties, often driven by inconsistent techniques, limited anatomical understanding, and a lack of standardized operating room (OR) practices. To reduce risk, OR teams require concise, evidence-based guidance that enhances their clinical understanding of nerve pathways, mechanisms of injury, and key patient and procedural risk factors. Standardizing safe positioning techniques—such as consistent alignment, padding, and limb support, reinforced by proper training and checklists—helps minimize variation from procedure to procedure. Intraoperative safety is further enhanced by clear communication amongst team members, establishing status checks, and ongoing reassessment of alignment and pressure points during longer cases. However, status checks and repositioning can be difficult once the patient is prepped and draped, so strategic padding, pressure redistribution techniques, and intraoperative vigilance should be employed to reduce injury risk when repositioning is not feasible. Interdisciplinary teams collaborate to create policies and procedures that mandate ongoing training and competency verification so that patient safety remains paramount within the OR venue.
Learning Objectives:
Identify common nerve injuries associated with prone, supine, and lateral positions with neuro/spine, ortho, and trauma specialties
Outline evidence-based positioning techniques to minimize the risk of perioperative nerve injury
Describe effective communication and documentation practices to ensure patient safety during surgical positioning
