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Tattoo in patients undergoing lumbar and thoracic subarachnoid puncture. Prevention behaviors

Journal of Anesthesia & Critical Care: Open Access
Luiz Eduardo Imbelloni, MD, PhD,<sup>1</sup> Anna Lúcia Calaça Rivoli, MD,<sup>2</sup> Sylvio Valença de Lemos Neto, MD, PhD,<sup>3</sup> Ana Cristina Pinho, MD,<sup>4</sup> Tolomeu A A Casali, MD, PhD,<sup>5</sup> Antonio Fernando Carneiro, MD, MSc, PhD<sup>6</sup>


The number of patients with tattoos and which are operated is increasing significantly in recent years. Some complications, mainly in neuraxial anesthesia, have been reported are unconvincing due to the lack of real evidence-based material. Tissue coring and deposition of epithelial cells in the CSF is a known entity. However, the theoretical risk exists and the anesthesiologist questions whether to puncture the neuraxial in patients with a tattoo at the puncture site. More organic pigments are being used and the precise composition of tattoo inks remains unknown. As a conduct for asepsis and antisepsis during spinal puncture (lumbar and thoracic), 14 steps were described to avoid neurological complications during spinal anesthesia. This approach during anesthesia in the neuraxial area meant that I never had a neurological complication, nor the appearance of an epidermoid tumor. Thus, a total of 17 steps that must be followed exactly when performing the puncture on the back of tattoo patients. If there is no pigment-free skin area available, a superficial skin incision is the method of choice.


Neuroaxial blocks; Tattoos; Tattooing; Complications; Tissue coring