SCS positioning

[paindoc2020]

How do you all position your patients for permanent SCS implant? I recently started doing implants again after a couple years off. I don’t recall specifically how we positioned in fellowship, but my memory is a few pillows/blankets under the stomach to arch the back and then face in a foam prone pillow, usually running on MAC with nasal cannula. I’m at a hospital that only uses CRNAs, there’s an Oakworks spine positioner they claim they need the patient to lay on “so there’s easy access to the airway if we need it”. I’m not anesthesia-trained but that seems excessive to me. And I feel like the positioner interferes with my ability to open up the space optimally for epidural access. I need to optimize my positioning for surgical technique, I don’t want to have inability to access airway if needed while I have the back wide open but that just seems like overkill to me, I don’t remember ever having a problem in training (which I think my fellowship also had CRNAs, though with anesthesiologist supervision instead of solo-practice CRNA).

Yes, I know I’m better off doing my cases somewhere with anesthesiologists. No argument from me on that. But for now, it is what it is.

---

Members don't see this ad.

 

[lobelsteve]

Your case, you decide positioning, not the nurses.

Depending on prior surgery, habitus, 3-4 folded blankets under navel to open up the T12-L1 interspace. Face in pink or purple foam. Thin pillow under chest, a few pillows under shins.

 

[drrosenrosen]

How do you all position your patients for permanent SCS implant? I recently started doing implants again after a couple years off. I don’t recall specifically how we positioned in fellowship, but my memory is a few pillows/blankets under the stomach to arch the back and then face in a foam prone pillow, usually running on MAC with nasal cannula. I’m at a hospital that only uses CRNAs, there’s an Oakworks spine positioner they claim they need the patient to lay on “so there’s easy access to the airway if we need it”. I’m not anesthesia-trained but that seems excessive to me. And I feel like the positioner interferes with my ability to open up the space optimally for epidural access. I need to optimize my positioning for surgical technique, I don’t want to have inability to access airway if needed while I have the back wide open but that just seems like overkill to me, I don’t remember ever having a problem in training (which I think my fellowship also had CRNAs, though with anesthesiologist supervision instead of solo-practice CRNA).

Yes, I know I’m better off doing my cases somewhere with anesthesiologists. No argument from me on that. But for now, it is what it is.

I'm calling bullspit on your CRNAs. You can access the airway with any of various types of prone positioning. Assuming they're doing MAC, just suggest that the pt can turn their head to the side.

 

[BobBarker]

The positioner works great. Just put some pillows or blankets under their belly. Help them take better care of the patient by using the positioner.

 

[callmeanesthesia]

The ASC I’m at now has one of those big oakworks frames. I just put a pillow on the lower portion of it and it worked fine. Not sure if it’s the same kind as yours but it’s high under the chest and then drops off, so it actually helps flatten out the lumbar lordosis. That said, if they want easy access to the airway they’re better off having the patient on just a couple pillows or towels and a face cushion as Lobel describes. You might be able to check the airway on the Oakworks but you can’t really access it to do anything and you couldn’t tilt the patient to the side like you could on pillows, without dumping them off the table.