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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Neuroaxial Blockade and Lumbar Tattoos and Obstetric Anesthisology practices

Abstract Number: T 21
Abstract Type: Original Research

Nadir Sharawi MBBS1 ; Mary Lou Greenfield MPH2; Jill Mhyre MD3


In recent years tattoos have become increasingly popular, including those located over the lumbar spine of women requesting neuraxial labor analgesia. Some anaesthesiologists have expressed concerns about placing neuraxial blocks through the tattoo pigmented tissue, based on the theoretical concern that tissue coring could lead to arachnoiditis, neuropathies, or epidermoid tumours. (1) Thus far there have been no reported neurological complications. We sought to determine the standard practices of academic obstetric anesthesiology divisions.


A 7 question Qualtrics® survey was emailed to 121 obstetric anesthesia directors from academic institutions across the United States to characterize practices of neuraxial blockade placement through lumbar tattoos in the setting of obstetric anesthesia. Univariate statistics were used to characterize survey results.


Seventy-six surveys were returned, for a response rate of 63%. While 38% of surveyed division directors (n=29) stated that they would insert neuraxial block at the optimal level regardless of pigmented tissue, 59% (n=45) would alter the neuraxial block position to avoid a tattoo if possible, but insert through a tattoo if necessary. Proposed strategies to avoid tissue coring include: 1) to always use a styletted needle when puncturing the skin with a needle intended for a neuraxial space; and 2) to make a small nick in the skin prior to epidural or spinal needle insertion. One director recommended against neuraxial anesthesia if tattooed skin is unavoidable. Ten percent of responders were aware of instances at their institutions in which a physician refused to place a neuraxial block through a tattoo. No respondents were aware of any complications attributed to neuraxial block placement through a tattoo, but several list the theoretical risks of tissue coring or aesthetic disruption of the tattoo as part of their informed consent discussion.

A Medline search for relevant publications using the keywords: (epidural OR spinal), AND (tattoo), AND (arachnoiditis OR neuropathy OR epidermoid tumor OR complications) did not identify any reports of complications from inserting a neuraxial block needle through a tattoo.


Most academic obstetric anesthesiology division directors would place a neuraxial block through a tattoo if necessary; the majority would attempt to avoid any pigmented tissue if possible. The theoretical risks of tissue coring and aesthetic tattoo disruption seem like reasonable topics to include in an informed consent discussion when placement through tattoo pigmented skin is unavoidable.


1. Epidural anaesthesia in three parturients with lumbar tattoos: a review of possible implications. Douglas MJ, Swenerton JE. Can J Anaesth 2002;49:1057-60.

2. Comparing response rates from Web and mail surveys: A meta-analysis. Shih T, Fan X. Field Methods 2008;20: 249-71.

SOAP 2013