title: Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial.
abstract: BACKGROUND
  previous evidences suggested that traditional sitting position (flexion of knees approximately 90°, and adduction of hips while feet rest on a stool) and hamstring stretch position (sitting position with maximum extension of knees, adduction of hips, and forward bending) both reversed the lumbar lordosis and the number of spinal needle-bone contacts were identical when placing patients in these positions for neuraxial block.
  
  
  OBJECTIVE
  In this study, we suggested that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts better than a traditional sitting position.
  
  
  METHODS
  Two hundred and thirty six patients ASA (American Society of Anesthesiologist) class I or II aged 18 to 75 years scheduled for elective surgeries under elective spinal anesthesia were randomized into two groups. We compared the traditional sitting and squatting positions. Our primary endpoint was the number of spinal needle-bone contacts, and secondary endpoint was ease of needle insertion or space identification.
  
  
  RESULTS
  The total number of spinal needle bone contact was statistically lower in the squatting position compared to traditional sitting position group (222 versus 230 respectively, P = 0.01). Insertion of needle was easy in 97 (87%) and 94 (84%) of patients and difficult in 20 (18%) and 17 (15%) of patients in traditional sitting and squatting positions, respectively (P = 0.59 and P = 0.12). Needle insertion was not impossible in any patients.
  
  
  CONCLUSIONS
  In squatting position the number of spinal needle-bone contacts was lower compared to the traditional sitting position, nonetheless ease of needle insertion or space identification was the same in the both groups.
authors.affiliation: Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sussan
authors.initials: S
authors.lastname: Soltani Mohammadi
authors.affiliation: Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Hassani
authors.affiliation: Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Mojtaba
authors.initials: SM
authors.lastname: Marashi
keywords: Anesthesia, Spinal; Spinal Needle; Squatting Position; Traditional Sitting Position