Abstract
Purpose
To discuss the possible ramifications of neuraxial analgesia and anesthesia in women with tattoos involving their midline lumbar area.
Clinical findings
Recently the authors have received requests for epidural anesthesia in three women with tattoos over the midline of their lumbar spine. In one patient the tattoo covered her entire back. In the other two, it was possible to locate a lumbar interspace that did not have tattoo pigment in the overlying skin. All three women received uneventful epidural analgesia.
A Medline and EMBASE search for relevant publications using the keywords: epidural, spinal, tattoos, tattooing, complications did not find any reports of complications from inserting a needle through a tattoo. As none were found, the literature on tattoos and on coring with neuraxial anesthesia was reviewed to see if neuraxial anesthesia might be problematic if the needle passed through the tattoo. Coring is a complication of neuraxial anesthesia that may lead to epidermoid tumours in the subarachnoid space. Theoretically, a pigment-containing tissue core from a tattoo could be deposited into the epidural, subdural or subarachnoid spaces, leading to later neurological complications.
Conclusions
There is no information in the literature about possible risks from inserting needles through tattoos during the performance of neuraxial anesthesia. This report discusses the possible implications.
Résumé
Objectif
Examiner les ramifications possibles de l’analgésie et de l’anesthésie neuraxiales chez des femmes qui ont des tatouages dans la zone lombaire médiane.
Éléments cliniques
Récemment, les auteurs ont reçu une demande d’anesthésie épidurale pour trois femmes ayant des tatouages au milieu de la colonne lombaire. Chez l’une des patientes, le tatouage couvrait entièrement le dos. Chez les deux autres, il a été possible de trouver un espace intercostal sans pigment de tatouage sur la peau sus-jacente. Les trois femmes ont reçu une analgésie épidurale sans incident. Lors d’une recherche dans Medline et EMBASE selon les mots clés epidural, spinal, tattoos, tattooing, complications, nous n’avons trouvé aucun article sur des complications causées par l’insertion d’une aiguille au travers d’un tatouage. Nous avons donc passé en revue la documentation sur le tatouage et sur le carottage lié à l’anesthésie neuraxiale pour vérifier si l’anesthésie neuraxiale pouvait être problématique dans le cas d’une aiguille qui perce un tatouage. Le carottage est une complication de l’anesthésie neuraxiale. Il pourrait causer des tumeurs épidermoïdes dans l’espace sous-arachnoïdien. Théoriquement, le carottage de tissu contenant du pigment de tatouage peut être déposé dans les espaces péridural, sous-dural ou sous-arachnoïdien et provoquer des complications neurologiques ultérieures.
Conclusion
Aucun risque possible lié à l’insertion d’aiguilles dans des tatouages pendant la réalisation de l’anesthésie neuraxiale n’a encore été documenté. Le présent article examine les implications possibles.
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Douglas, M.J., Swenerton, J.E. Epidural anesthesia in three parturients with lumbar tattoos: a review of possible implications. Can J Anesth 49, 1057–1060 (2002). https://doi.org/10.1007/BF03017902
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DOI: https://doi.org/10.1007/BF03017902