Summary Summary: In addition to anaesthesiology, numerous other specialties are now making use of diagnostic and/or therapeutic procedures that may be associated with an intentional or unintentional perforation of the dura. A case of postdural-puncture headache and its treatment with caudal saline injections was reported at our instition in 1996. It was a 42-year-old man with radicular neuralgia secondary to a vertebral compessi-on fracture involving Th7-Th 8, who had undergone a peridural block during the course of ambulatory pain treatment. The aim of the present study is to examine the effec-tiveness of this therapeutic approach with the newly developed concept for handling postdural-puncture headache by caudal saline injections at a larger patient collective at our hospital. The decisive criterion for being considered in our study was the aggravating headache symptomatology by change in upright posi-tion,coughing and straining. For this purpose,53 patients at an age of 26 to 63 years, who had suffered from postdural-puncture headache between 1995 and 1999 after spinal or epidural anaesthesia for surgery on the lower half of the body as well as diagnostic or therapeutic lumbar puncture were included in our investigation. The incidence of postdural-puncture headache over the last 4 years averaged on a rate of 6% in this study. Two patients with a history of headache were excluded. After preparing the patient in prone position with a pillow under the pelvis,the sacral hiatus could be mar-ked under sterile conditions by palpating the tip of the coccyx with the fingertip and moving cephalad about 4 to 5 cm over the sacral hiatus with the prominent sacral cornua palpable on each side by moving the fingertip from side to side.While infiltrating the punctu-re side with 1% Lidocain as a local anaesthetic, the sacral hiatus could be entered using "loss of resi-stance"-technique.A subcutaneous bulge or superfici-al crepitus after injection of 2-3 ml of local anaesthetic solution or air should be excluded. The needle size used for this procedure was 20-gauge and 50 mm of length.During the injection of normal saline with a 20 ml syringe, which was connected to a Heidelberger extension tube and attached to the needle,the patients were asked continuously for pain relief using the visual analog scale (VAS).The percentage of pain relief after the injection of saline solution was also documented in each case.The injection was continued for an average time of 20 minutes in all patients until a small,subjec-tively bearable headache indicated by the patient remained. Two to three injections per day with an average of 120 ml normal saline solution over 2 - 3 days were necessary; the remainder headache indicated here by the patients amounted to an average of 6% of the initially existing symptomatology. In four out of the 53 patients included in the study, postdural-punc-ture headache could only be managed by epidural blood patch because caudal saline injections failed to relief pain. Thus, the use of caudal saline injections for handling postdural-puncture headache represents an effective and rational supplementation of the available anaesthetic possibilities at the hospital. Serious com-plications did not occur since introduction of this the-rapeutic procedure, so that its application as a simple and cost saving measure with a high success rate can be recommended also for the handling of postdural-puncture headache in ambulatory patients for pain practice outside of the hospital.