Do peroperative supine and prone positions have an effect on postspinal headache incidence?

Objectives: The study was planned to investigate thepossible effects of peroperative prone and supinepositions on postspinal headache incidence.Methods: This prospective study was completed atDemet Hospital, Ankara, Turkey between January-July2003. Two groups of patients were studied, Group 1comprised randomly selected male American Society ofAnesthesiology Classification grade 1 (ASA 1) patientswith an age range of 20-40, who were scheduled forpilonidal sinus operation. Group 2 comprised randomlyselected male ASA1 patients with an age range of 20-40who were planned for knee arthroscopy. After bothgroups were given spinal anesthesia in the sitting positionwith a 22-gauge Quincke needle, the patients who werescheduled for pilonidal sinus operation were laid in theprone position, while the patients planned for arthroscopywere laid in the supine position. The patients were thenasked about postoperative headache complaints on thepostoperative 3rd and 7th days. All patients wereobserved postoperatively for 2 days for analgesia. Bothgroups used only paracetamol 500mg orally forpostoperative analgesia and oral fluid intake waspermitted 3 hours after operation.Results: The postoperative headache incidence ofGroup 2 (patients operated in supine) position wasstatistically higher than that of Group 1 (patients operatedin prone). The higher incidence of post spinal headachein the supine position was attributed to increasedcerebrospinal fluid loss due to gravity and increased intraabdominal pressure associated with this position.Conclusion: Spinal anesthesia can be a safe method foroperation in the anal area in the prone position, and theprone position may prove superior to the supine positionwith respect to post-dural puncture headachedevelopment after spinal anesthesia practices.