Background: Postoperative pain outside the surgical area is often overlooked but can affect patient recovery. Intraoperative positioning causes uneven pressure distribution, tissue compression, and nerve strain that trigger pain at non-surgical sites. This study evaluated the effect of surgical position on postoperative pain characteristics and consistency of findings across subpopulations. Objective: To compare pain occurrence, location count, and intensity across three surgical positions in the first 24 hours postoperatively. Methods: Observational cross-sectional study of 340 adult elective surgery patients (duration ≥2 hours): supine n=187, lateral n=119, prone n=34. Pain assessment at 6, 12, 18, 24 hours using Numerical Rating Scale (NRS) and 20-location anatomical map. Analyses included Kruskal-Wallis, Mann-Whitney U with Bonferroni correction (α=0.017), and stratified multiple regression by anesthesia type: general anesthesia with intubation (n=191), general anesthesia with LMA (n=74), regional anesthesia SAB (n=75). Dependent variable was pain location count at 24 hours; independent variables were surgical position, BMI, operation duration. Results: Pain location count differed significantly between positions at all timepoints (H=256.949-257.875, df=2, p0.001). Median lateral and prone were 12-15 locations at 6-12 hours and 12 locations at 18-24 hours, significantly higher than supine (5 locations at 6-12 hours, 1-3 locations at 18-24 hours). Post-hoc: supine vs lateral U=0.0-1.0, p0.001; supine vs prone U=0.0, p0.001; lateral vs prone U=1980.5, p=0.846. Pain intensity differed significantly (H=177.223, df=2, p.001) with median NRS lateral 4.41-7.41, supine 2.51-5.51, prone 2.39-5.39. Stratified regression analysis showed remarkable consistency: lateral coefficients in GA intubation B=10.698 95% CI: 10.379-11.016, p0.001, R²=0.949, GA LMA B=10.565 95% CI: 9.896-11.233, p0.001, R²=0.933, RA SAB B=10.688 95% CI: 10.159-11.217, p0.001, R²=0.969. Coefficient range only 0.133 (1.26% variation), indicating universal effect not modified by anesthesia type. Prone in GA intubation: B=10.840 (p0.001). All confounders p>0.05, VIF 1.5. At 24 hours, 23.5% supine patients were pain-free versus 0% lateral and prone. Conclusion: Surgical position significantly affects postoperative pain. Lateral produces highest burden (12-15 locations, NRS 4.41-7.41), supine lowest (1-5 locations, NRS 2.51-5.51), prone intermediate (12-15 locations, NRS 2.39-5.39). Stratified analysis showed lateral coefficient consistency 1.3% across three anesthesia groups, indicating universal effect and strengthening causal inference. Position is the dominant predictor with non-significant confounders. Findings support universal positioning optimization strategies, especially for lateral position.
Keywords: Surgical positioning, Postoperative pain, Pressure injury, Perioperative care
How to cite this article: Abednego RT, Kriswidyatomo P, Putri HS., The Effect of Surgical Position on Pain Occurrence Outside the Surgical Area. Int J Drug Deliv Technol. 2026;16(1): 199-209. DOI: 10.25258/ijddt.16.1.21