General Surgery - Surgery in the prone position

This information leaflet is for anyone undergoing surgery in the prone position (lying on their front). The most common type of surgery where you are required to be in this position is spine surgery.

This leaflet has been written with the help of patients who have undergone surgery in the prone position.

Spine surgery

In order for your operation to be carried out, the spinal surgeon will need to gain access to your spine during the operation and therefore you must be lying on your front and face down.

Why is it important to read about the prone position?

Most operations are carried out with the patient lying on their back. Because we are not designed to lie on our front, there are more risks with operations where the patient is in the prone position. This is especially the case when the patient is required to be in the prone position for several hours.

Before your surgery

• On the day of your surgery, you will attend the Surgical Admission Lounge. Your anaesthetist will talk to you about the general anaesthetic as well as the prone position. You will be able to ask your anaesthetist any questions you may have
• You will be taken to the anaesthetic room. The anaesthetic team will attach monitoring equipment to you. This is standard for anyone undergoing a general anaesthetic (see leaflet titled You and Your Anaesthetic)
• Your anaesthetist will put you to sleep (general anaesthetic) while you are lying on your back
• When you are asleep, you will be turned onto your front (the prone position) by a team of experienced staff
• Your anaesthetist will monitor you closely throughout this process

After your surgery

• When your surgery is complete, you will be transferred onto a bed and turned onto your back
• So, when you wake up, you will be lying in the same position as you were in before going to sleep

Side effects and risks of the prone position

Common

• Redness, tenderness and bruising on your pressure areas; especially the chest, hips, and knees
• Swelling of the face, eyelids, chin, lips and tongue. Swelling in these areas may lead to breathing difficulties afterwards. Your anaesthetist will discuss this in further detail if you are at risk of this
• Women may experience breast tenderness. In women with breast implants, there is risk of one or both implants rupturing
• Men may experience swelling or tenderness to their genitalia

Uncommon

• Contact dermatitis (rash)
• Damage to your skin
• Pressure sores

Rare

• Shoulder dislocation
• Nerve damage
• Blindness
• Stroke
• Cardiac arrest. Being placed in the prone position is a major stress on the body, especially the heart. In certain medical conditions, there is a high risk of your heart stopping when you are turned onto your front. Your anaesthetist will discuss this if this applies to you

Special circumstances

For most people, the operating table can be adapted to suit their body shape and size. However, certain medical conditions will make putting them in the prone position difficult.

For some people, a specialised table may have to be constructed to carry out their operations safely.

Examples of these conditions include obesity, women with breast implants, and ankylosing spondylitis.

If your surgeon or anaesthetist suspects that putting you in the prone position may be challenging, they may make an appointment for you to come in and position yourself on the operating table whilst you are awake to make sure that there will be no problems on the day of your surgery.

Minimising the side effects and risks

When you are placed into the prone position on the operating table, the medical team will check that there is no direct pressure on your eyes throughout the operation and that padding is applied to delicate pressure areas.

The diagram below shows the common prone position.

There are other variations of this depending on the type of surgery.

For further information, please contact:

Dr Ming Wilson Consultant Anaesthetist
Email: ming.wilson@nca.nhs.uk
Telephone: 0161 206 5870