ORIGINAL ARTICLE 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 Marc D. Schmittner & Nicole Urban & Andrea Janke & Christel Weiss & Dieter G. Bussen & Marc A. Burmeister & Grietje C. Beck Accepted: 8 July 2010 / Published online: 22 July 2010 # Springer-Verlag 2010 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 ano- rectal 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). Sources of funding for research The spinal needles were allocated free of charge by courtesy of B. Braun, Melsungen, Germany. M. Schmittner received financial support (fee, hotel, travel-costs) for presenting parts of the study at the Congress of the German Society of Colo-Proctology, Munich, Germany (March 2009), at the annual congress of the European Society of Anaesthesiology, Milan, Italy (June 2009) and at the HAI-Congress, Berlin, Germany (September 2009). M. D. Schmittner (*) : N. Urban : A. Janke Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany e-mail: marc.schmittner@umm.de C. Weiss Department of Medical Statistics, University Medical Centre Mannheim, Mannheim, Germany D. G. Bussen Centre of Colo-Proctology, Mannheim, Germany M. A. Burmeister Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany G. C. Beck Department of Anaesthesiology, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany M. A. Burmeister B. Braun, Melsungen, Germany Int J Colorectal Dis (2011) 26:97–102 DOI 10.1007/s00384-010-1012-8