The aim of this randomised clinical trial was to determine whether spinal anaesthesia (SPA) is superior to total intravenous anaesthesia (TIVA) in patients undergoing pilonidal sinus (PS) operations in the prone position. After approval of the local ethics committee, suitable patients aged 19-49 years were randomised to SPA (7.5 mg hyperbaric bupivacaine) or TIVA (Propofol and Fentanyl). Cumulative consumption of analgesics, postoperative recovery, complications and patient satisfaction were evaluated. A total of 50 patients were randomised within a 24-month period. Median monitoring time in the recovery room was 0 (0-11) min for SPA versus 40 (5-145) min for TIVA (p < 0.0001). Patients in the SPA group were able to drink (40.5 (0-327) min versus TIVA 171 (72-280) min, p < 0.0001) and eat (55 (0-333) min versus TIVA 220 (85-358), p < 0.0001) earlier. More patients with a TIVA needed analgesics in the recovery room (SPA n = 0 versus TIVA n = 6, p = 0.0023) and suffered more frequently from a sore throat (SPA n = 0 versus TIVA n = 11, p = 0.0001). Two patients with a TIVA suffered from nausea and vomiting. Patients of both groups were equally satisfied with the anaesthesia technique offered. SPA with 7.5 mg hyperbaric bupivacaine is superior to TIVA in patients undergoing PS operations in the prone position in terms of analgesia consumption in the recovery room, recovery times and postoperative complications. Schmittner, Dieterich, Gebhardt, Weiss, Burmeister, Bussen, Viergutz, , (2013). Randomised clinical trial of pilonidal sinus operations performed in the prone position under spinal anaesthesia with hyperbaric bupivacaine 0.5 % versus total intravenous anaesthesia. International journal of colorectal disease, 2013 Jun;28(6):873-80. https://www.ncbi.nlm.nih.gov/pubmed/23196892