Epidurals/Tatoos

[bagladyrn]

There is a thread going on on the OB forum right now concerning the safety of administering epidurals through a tatoo. Apparently some anesthesia providers won't do them if it is necessary to go through an inked area.

I was wondering what you all know about this and what your experience has been.

Thanks!

[zrmorgan]

The Canadians...

Can J Anaesth. 2002 Dec;49(10):1057-60

"Based on the limited information available it is possible that inserting an epidural or spinal needle through a tattoo could cause long-term problems such as arachnoiditis or a neuropathy secondary to an inflammatory reaction, but we don't know. Until recently neither of the authors had seen a tattoo over the lumbar spine and this report is to draw attention to others regarding possible risks attending neuraxial anesthesia with these women."

The French...

1: Ann Fr Anesth Reanim. 2006 Jan;25(1):71-3. Epub 2005 Dec 28

"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."

Interesting case presented in an Editorial...

Labour analgesia in a parturient with lumbar tattoo: a routine management? or not?

Krzysztof M. Kuczkowski, MD

San Diego, California

To the Editor:

Douglas and Swenerton first reported on the administration of labour analgesia in three parturients with lumbar tattoos and discussed the possible ramifications of neuraxial analgesia in women with tattoos in the lumbar area.1 All three women received uneventful epidural analgesia, and no anesthesia-related complications were reported. I herein present a similar case, and the first report of a minor anesthesia complication resulting from epidural needle insertion through tattoos during the performance of neuraxial block. A 34-yr-old, healthy female at term was in labour and requested labour analgesia. Preanesthetic back examination revealed the colourful tattoos covering her entire lumbar area. An epidural block was performed in a standard manner (one attempt at L2-3 interspace) with an 18-gauge Tuohy needle. Several hours after an uneventful delivery, the patient reported tenderness and burning in the lumbar area where the epidural catheter had been sited. Examination revealed a localized L2-3 interspace tenderness, however, due to the presence of a tattoo in this area, skin redness (irritation) could not be determined. The neurological examination was normal and her symptoms resolved over the next 24 hr. A pigment-containing tissue core from a tattoo seems a possible cause of deeper lumbar tissue irritation.

I guess the whole problem would be "coring" or ectopic pigment in the wrong place...don't know if I would go as far as to make an incision before placing the Thouy, but I might have a lengthy discussion with the Parturient about the possibilities of above...

tough call...good luck

Z

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

I do epidurals thru tats, but I also tell them that their MAY be a higher risk of infection. I have not seen any problems and I have never refused for this reason. Actually the only refusals I give are for platelets under 100. It will even attempt scoliosis patients. You never know, usually they can be placed. I've only found 1 so far that I couldnt get. (that's a whole other story!!!)

[miloisstinky]

I had never heard of this!!!!!!!!!:uhoh21::uhoh21::uhoh21:

I wish I had thought about this more thoroughly as a stupid 18 year old gettin a huge meaningless lower back tattoo.......now im a silly 30 plus chick who may have to suffer thru every pain of the labor process.....stupid kid.

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

]CRNA's at the hospital I had worked at would have had a DUCK if they had to place an epidural in a labor pt. They got ****** off if they had to get up out of bed for a c-section during the night.

Lisa

That is sad. I am disappointed in any CRNA that will willingly limit their own practice due to laziness. That is unprofessional and very bad for us as a group.