title: Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery.
abstract: BACKGROUND
  The patient's position during spinal anesthesia administration plays a major role in the success of spinal needle insertion into the subarachnoid space. The traditional sitting position (TSP) is the standard position for spinal anesthesia administration, but the success rate for spinal anesthesia administration in the TSP is still quite low. The crossed-leg sitting position (CLSP) is one of the alternative positions for the administration of spinal anesthesia, which can increase the degree of lumbar flexion.
  
  
  OBJECTIVE
  This study aimed to compare successful spinal needle placement to patients in the CLSP and patients in the TSP prior to undergoing urology surgery.
  
  
  METHODS
  This study was a non-blinded, randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures from March-October, 2015 in the central national hospital Dr. Cipto Mangunkusumo, Indonesia. After obtaining approval from the FMUI - RSCM (Faculty of Medicine Universitas Indonesia - Rumah Sakit Dr. Cipto Mangunkusumo) Ethical Committee and informed consent from patients, 211 subjects were allocated into two groups: the CLSP group (n = 105) and the TSP group (n = 106). The proportion of successful spinal needle placement to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contacts in both groups were then assessed and analyzed.
  
  
  RESULTS
  The rate of first-time successful spinal needle insertion was not significantly different between the CLSP and TSP groups (62.9% versus 55.7%, P > 0.05). Ease of landmark palpation in the CLSP group was not significantly different from that in the TSP group (86.7% versus 76.4%, P > 0.05). The number of needle-bone contacts in both groups were not significantly different (P > 0.05). The complication rates were similar in both groups.
  
  
  CONCLUSIONS
  The rate of successful spinal needle placement in the CLSP group was not significantly different from that in the TSP group in patients undergoing urology surgery. The CLSP can be used as an alternative sitting position for administration of spinal anesthesia.
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Sidharta K
authors.initials: SK
authors.lastname: Manggala
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Aida R
authors.initials: AR
authors.lastname: Tantri
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Darto
authors.initials: D
authors.lastname: Satoto
keywords: Crossed-Leg Sitting Position; Landmarks; Needle-Bone Contact; Spinal Needle Placement; Traditional Sitting Position