Intra-abdominal hypertension due to surgical position increases bleeding at the surgical site. In this study, we evaluated the impact of prone and jackknife position on intra-abdominal pressure (IAP), lung mechanics, blood loss at the surgical site, and duration of the surgical procedure on lumbar disc operations.
Forty patients operated for single-space lumber disc herniation were included in our study. All patients were ASA I-II and 18 to 70 years old. Patients who had undergone previous spinal surgery, were on anticoagulant or anti-aggregant therapy, had hypertension, cardiac, respiratory, liver, or renal disorders, and were obese (Body Mass Index >35 kg/m2) were excluded. Patients were randomly assigned to either the prone or the jackknife position for surgery. Differences in lung mechanics, IAP, and surgical-site blood loss were calculated in both patient groups. Changes in pulmonary and abdominal pressure levels were measured both in face-up and down positions.
Bleeding at the surgical site (prone: 180.0±100.0 mL, jackknife: 100.0±63.6 mL, P=0.018) and IAP (prone: 11.0±3.0 mm Hg, jackknife: 8.0±2.0 mm Hg, P=0.006) were significantly reduced when patients were in the jackknife position. Operating time was approximately 40 minutes shorter in the jackknife position group, although this difference was not significant.
The jackknife position causes less IAP elevation and less surgical site bleeding compared with the prone position. The jackknife position is the preferred choice for single-level lumbar disc surgery in healthy, nonobese patients.
*Department of Anesthesiology and Intensive Care
†Department of Neurosurgery, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri, Capa, Istanbul, Turkey
The authors have no funding or conflicts of interest to disclose.
Reprints: Ibrahim Ozkan Akinci, MD, Department of Anesthesiology and Intensive Care, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri, Mono Blok 34390, Capa, Istanbul, Turkey (e-mail: firstname.lastname@example.org).
Received February 22, 2011
Accepted June 27, 2011