[Epidural anaesthesia and lumbar tattoo: what to do?]

More and more often, the anaesthesiologist may have to perform lumbar epidural anaesthesia in a patient with a central lumbar tattoo, and this can occur in an urgent obstetric setting. Before managing two uneventful cases of epidural analgesia for labour, we have performed a literature review and noted that no serious complication has been reported. Nonetheless, a needle passed through a tattoo can entrap pigmented tissue fragments (cores) into the epidural or subarachnoid space. This could theoretically induce risk of late neurological complications, related to an inflammatory or granulomatous response to the pigmented cores introduced in these spaces. To avoid this theoretical risk, the anesthesiologist should try to avoid puncturing through the tattoo, either by selecting a different vertebral interspace, or by using a paramedian approach or by finding a pigment free skin spot within the area of the tattoo. When these options cannot be implemented, a superficial skin incision prior to needle insertion should prevent from coring tattoo pigment when entering the skin. Whatever the final choice, the technique to be implemented should be determined as early as the antenatal visit, after informed consent.