|LETTER TO EDITOR
|Year : 2013 | Volume
| Issue : 6 | Page : 627-628
Neuraxial techniques in patients with lumbar tattoos: A national survey from New Zealand
Kiran Polisetty, Saleem Khoyratty, Martin Minehan
Department of Anaesthesia, National Womens Health, Auckland City Hospital, Auckland, NewZealand
|Date of Web Publication||20-Dec-2013|
Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Polisetty K, Khoyratty S, Minehan M. Neuraxial techniques in patients with lumbar tattoos: A national survey from New Zealand. Indian J Anaesth 2013;57:627-8
|How to cite this URL:|
Polisetty K, Khoyratty S, Minehan M. Neuraxial techniques in patients with lumbar tattoos: A national survey from New Zealand. Indian J Anaesth [serial online] 2013 [cited 2019 Dec 6];57:627-8. Available from: http://www.ijaweb.org/text.asp?2013/57/6/627/123346
Throughout the world, many Anaesthetists come across lumbar tattoos. On most occasions, the tattoo covers only one or two lumbar interspaces, allowing the anaesthetist to choose another interspace devoid of tattoos. However, it is becoming increasingly common to be faced with a patient whose back is fully covered with tattoos especially in New Zealand (NZ) and Australia. Frequently, these patients with lumbar tattoos are females in the reproductive age group, thus obstetric Anaesthetists are more likely to view them on a regular basis. Most of these tattoos are cosmetic, but occasionally they are traditional or culturally significant for the bearers.
Tattoos are pigments or indelible ink deposited in the dermis of the skin. Modern tattoo ink components may include organic and inorganic compounds, metals and solvents.  Many pigments are not intended for use in humans and the tattoo artists are not regulated by federal agencies. 
Tissue coring and deposition of epithelial cells in the cerebrospinal fluid is a known entity.  Occurrence of epidermoid tumours following neuraxial needle insertion is reported in the past.  There has not been any prospective studies or chemical analysis to prove that tattoo inks are not neurotoxic. There is no consensus regarding safety thus far and junior anaesthetists rely on expert opinion, which is variable.
A national survey on safety of neuraxial anaesthesia in patients with lumbar tattoos was conducted in NZ.
We invited all trainees and specialists in NZ to respond to an electronic survey containing seven questions.
A total of 158 Anaesthetists from all the regions of NZ participated in the survey of which 78% were consultants and the remainder was trainees.
Nearly, 45% of respondents considered it is safe to perform neuraxial technique through a lumbar tattoo and 45% did not know whether it was safe or unsafe while 9% considered it unsafe. 96% were not aware of any mishaps related to administering neuraxial anaesthetic through a lumbar tattoo. Nearly 65% did not feel that a small skin-deep incision should be performed prior to insertion of the neuraxial needle while 35% did. Nearly 87% do not explain the theoretical possibility of chemical meningitis or epidermoid tumour to their patients with lumbar tattoos while 12% routinely do 98% did not recommend general anaesthetic in patients with extensive lumbar tattoos in a setting where regional anaesthesia would normally be the preference.
Our survey suggests that the majority of the respondents do not consider extensive lumbar tattooing as a contraindication for neuraxial anaesthesia and analgesia. Though the consensus is split regarding the safety with half of the respondents not knowing whether it is safe, majority of respondents do not routinely consent patients to the risks of tattoo ink coring. This survey highlights that a third of the respondents perform a skin-deep incision prior to insertion of neuraxial needle in patients with lumbar tattoos.
Based on the results of the survey and paucity of evidence in the current literature regarding neuraxial blocks through tattooed skin, we do not recommend exposing patients to this rare theoretical risk, but we do recommend choosing the least tattooed lumbar interspace and performing an adequate skin-deep incision prior to insertion of a neuraxial needle.
| References|| |
|1.||Timko AL, Miller CH, Johnson FB, Ross E. In vitro quantitative chemical analysis of tattoo pigments. Arch Dermatol 2001;137:143-7. |
|2.||US Food and Drug Administration. Think before you ink: Are tattoos safe? http://www.fda.gov/ForConsumers/Consumer Updates/ucm048919.htm . [Last accessed on 2013 Jul 30]. |
|3.||Guldogus F, Baris YS, Baris S, Karakaya D, Kelsaka E. Comparing tissue coring potentials of hollow needles without stylet and caudal needles with stylet: An experimental study. Eur J Anaesthesiol 2008;25:498-501. |
|4.||Refai D, Perrin RJ, Smyth MD. Iatrogenic intradural epidermoid cyst after lumbar puncture. Case illustration. J Neurosurg 2007;106:322. |