The effects of Trendelenburg Position on Patient Care during Open Radical Prostatectomy: A Randomized Controlled Clinical Trial

Background: Low quality of surgical field is a common problem during open radical prostatectomy (ORP). Aim: This study was performed aimed to survey the effects of Trendelenburg position on the quality of surgical field, mean arterial blood pressure (MABP), heart rate (HR), regional cerebral oxygen saturation (rSO۲) and cognitive function in patients undergoing ORP. Method: This randomized controlled clinical trial study was done on ۶۰ patients candidates for ORP in Shahid Beheshti Hospital of Hamadan in ۲۰۲۲. Patients were selected by the convenience sampling method and were divided into two intervention and control groups using the random blocking method. In intervention group, patients were placed in a ۱۵° head-down tilt before surgery. The control group was remained in a sleeping position on the back during surgery. The surgical field quality was assessed after surgery. The MABP, HR, and rSO۲ were assessed after anesthesia induction, after positioning, and consecutively in ۳۰-minute intervals during the surgery. Results: The mean age was ۶۰.۹۳±۴.۲۴ years. A significant difference was found between the two groups regarding the surgeon's satisfaction with the surgical field quality (P=۰.۰۴). There was a significant difference between the two groups regarding surgery time (t=-۳.۰۰, P=۰.۰۰۴). No significant differences were found between the two groups in terms of MABP, HR, and rSO۲ in either of the measurements (P>۰.۰۵). Implications for Practice: It is recommended to use Trendelenburg position, as a safe position, to improve exposure to the pelvis during surgery.

Keywords:

Head-down tilt , Hemodynamics , Intraoperative , Prostatectomy , Surgical field