Inflatable pillows as axillary support devices during surgery performed inthe lateral decubitus position under epidural anesthesia

The lateral decubitus position can cause dependent shoulder discomfort or r esult in traction on the brachial plexus. We measured pressure beneath the dependent shoulder and lateral angulation of the cervical spine in patients positioned in the lateral decubitus position for total hip replacement und er epidural anesthesia. Inflatable pillows (Shoulder-Float (TM)) beneath th e chest wall and head reduced pressure beneath the dependent shoulder from 66 to 12 mm Hg (P < 0.001) and lateral angulation of the cervical spine fro m 14 degrees to 4 degrees (P < 0.001). In a randomized crossover study of a further 15 patients, the use of inflatable pillows resulted in significant ly less pressure beneath the dependent shoulder and chest wall than either a gel-pad or a 1000-mL lactated Ringer's bag. Inflatable pillows placed ben eath the chest wall and head in the lateral decubitus position provided low er pressure beneath the dependent shoulder than other support devices and f acilitated alignment of the cervical spine.