title: Influence of the pre-operative time in upright sitting position and the needle type on the incidence of post-dural puncture headache (PDPH) in patients receiving a spinal saddle block for anorectal surgery.
abstract: BACKGROUND
  A spinal saddle block can be a safe method for anorectal surgery with a low rate of complications when performed with the right technique. A dreaded complication is the post-dural puncture headache (PDPH), which can be decreased by the use of non-cutting spinal needles. Regrettably, cutting Quincke (Q)-type needles are still widely used for economic reasons. Besides size and design of a spinal needle, the pre-operative time in upright sitting position may also influence the incidence of PDPH after spinal saddle block.
  
  
  METHODS
  Within 4 months, 363 patients undergoing anorectal surgery in saddle block technique were randomised to receive either a 27-gauge (G) pencil-point (PP) or a 27-G Q spinal needle and were pre-operatively left in upright sitting position for 10 or 30 min, respectively. The incidence of PDPH was assessed 1 week after the operation via a telephone interview.
  
  
  RESULTS
  Three hundred sixty three patients (219 males/144 females) were analysed. Fifteen patients (4.1%) developed PDPH. Patients receiving spinal anaesthesia with a Q needle suffered significantly more frequently from PDPH [Q: n = 12 (6.6%) vs. PP: n = 3 (1.7%), p = 0.02], but there was no association between PDPH and pre-operative time in the upright position (p = 0.20).
  
  
  CONCLUSIONS
  These data prove that using 27-G PP needles is the method with the fewest side effects caused by spinal saddle block, and suggest that the time spent sitting in the upright position is not clinically relevant.
authors.affiliation: Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. marc.schmittner@umm.de
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schmittner
authors.forename: Nicole
authors.initials: N
authors.lastname: Urban
authors.forename: Andrea
authors.initials: A
authors.lastname: Janke
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Dieter G
authors.initials: DG
authors.lastname: Bussen
authors.forename: Marc A
authors.initials: MA
authors.lastname: Burmeister
authors.forename: Grietje C
authors.initials: GC
authors.lastname: Beck
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D003710:Demography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009339:Needles; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D051299:Post-Dural Puncture Headache / Q000453:epidemiology* / Q000209:etiology*; D011187:Posture; D012007:Rectum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome