Epidural anesthesia in three parturients with lumbar tattoos: a review of possible implications

To discuss the possible ramifications of neuraxial analgesia and anesthesia in women with tattoos involving their midline lumbar area.

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.

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.