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
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.