Proper Patient Positioning Guidelines: Reverse Trendelenburg Position

July 16, 2018
reverse trendelenburg positioning

In Reverse Trendelenburg the OR table is tilted with the feet facing downward and the head 15 degrees to 30 degrees higher.1 The surgical site is elevated above the level of the heart to improve drainage of bodily fluids away from the surgical site, reducing intracranial pressure and decreasing bleeding in the surgical field. This position is used for head and neck procedures and provides visualization in laparoscopic procedures of the upper abdomen. Compression devices and anti-embolism stockings should be used to prevent pooling of blood in the legs. As with Trendelenburg, movement into and out of this position should be done slowly to allow time for the patient’s heart to adjust to change in blood volume. A foot extender or positioning strap can be used to help secure the patient from sliding on the table.

A variant of the supine position, the head is supported by a headrest, keeping it in a neutral position so the head and spine are aligned. The arms are typically at rest by the patient’s side or on padded arm boards. When arm boards are used, the arms should be extended at less than a 90-degree angle from the body to prevent ulnar and radial nerve compression.1 When arms are positioned at the patient’s side the palm should rest against the patient and the elbows should be padded.

Patients under sedation, regional anesthesia or general anesthesia lack normal perception and protective reflexes and are thus at increased risk for positioning injury.1 Therefore, they are unable to speak up if complications from improper positioning include injuries to the skin, cardiovascular and respiratory compromise, and musculoskeletal pain and dislocation.2


  1. Burlingame B, Davidson J, Denholm B, et al. Guideline for positioning the patient. Guidelines for Perioperative Practice. 2017;1. DOI: 10.6015/psrp.17.01.e1.
  2. Beckett AE. Are we doing enough to prevent patient injury caused by positioning for surgery? J Perioper Pract. 2010;20(1):26. PMID: 20225718.