A Colorful Gray Area

From the annual meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP), San Antonio 

Here’s something a young woman might not think about when deciding to get her back tattooed: Doing so could prevent her from receiving spinal or epidural anesthesia during childbirth. 

Photo by Melvin Moten Jr., used with permission


In a survey of 432 anesthesiologists at 64 maternity hospitals across Ontario, 8-10% said they would refuse labor epidural anesthesia for a woman who had an old, uncomplicated, complete lumbar spine tattoo, and 10-13% said they would refuse spinal anesthesia for an elective Cesarean section in the presence of such a tattoo. (The ranges represent different levels of neonatal care at the respondents’ hospitals.) 

Approximately 1 in 5 community-based anesthesia providers and 1 in 6 university providers said that they would use general anesthesia instead for an elective C-section due to even an old, uncomplicated complete lumbar spine tattoo, Dr. Pamela Angle, of the University of Toronto, reported in a poster. 

Two-thirds of the respondents cited possible neurologic complications as a concern, 38-44% listed medicolegal concerns, 1 in 5 feared infection, and 15-19% worried about scarring the tattoo. In general, providers working in centers with neonatal tertiary care departments were less likely to opt for general anesthesia simply because of a lumbar tattoo than were those in small town or rural hospitals without specialized neonatal care units. 

During a poster review session at the meeting, Dr. Angle noted that pigments used in tattoos are not standardized or regulated, and it’s often impossible to know what ingredients they contain. Nonetheless, most of it becomes encapsulated by fibroblasts and other immune cells in the dermis in about a month to 6 weeks. Some obstetric anesthesiologists would be willing to perform epidural or spinal anesthesia at that point as long as there were no complications such as signs of infection, inflammation, or non-healing. However, Dr. Angle said she prefers a threshold of about three months after receipt of an uncomplicated tattoo, based on case reports in the literature of muscle atrophy and hypersensitivity associated with relatively recent tattoos. 

Of course, she said, efforts should be made to simply avoid the inked area. This is often possible with small lumbar tattoos, but not with full-back tattoos that completely cover the lumbar region. In those cases, “My practice would be to get informed consent, and explain that this is a gray area.” Even if it’s multicolored. 

-Miriam E. Tucker (@MiriamETucker on Twitter) 

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Filed under Allergy and Immunology, Anesthesia and Analgesia, Dermatology, Family Medicine, IMNG, Infectious Diseases, Internal Medicine, Neurology and Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Primary care, Uncategorized

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