Hi. I am the chief nurse anesthetist at my hospital, and I would like to offer some information about the tattoo issue and labor epidurals. My staff of CRNAs administer all the spinals and epidurals at our medical center, and we frequently have people with lumbar region tattoos. While there have been many questions lately regarding whether epidurals through tattoos are safe or not, the bottom line is that we don’t really know. There has been a very small amount written in the anesthesia literature about this issue, and the opinions expressed and the small amount of anecdotal data indicate that epidurals through tattoos have not caused problems, in spite of the theoretical risk of introducing a foreign substance into/near the spinal cord. We do know that a variety of other substances, drug preservatives, etc. DO cause irritation when introduced there, even in very minute amounts. While epidurals and spinals seem not to cause problems, keep in mind that lower back tattoos have only gained widespread popularity in recent years. Sometimes things that seem safe in the beginning turn out to be the cause of problems, but only after much time and many people have tested it. A good example is the arthritis drug, Vioxx, which was very popular for 5 years, before recently being determined to increase the risk of heart attacks and stroke.

We’ll have much better information in 5 or 10 more years to determine if there is any increased risk of tracking a needle through a tattoo to the spine. In the meanwhile, I personally will perform a puncture through a tattoo, but try for a “clean” spot of skin whenever possible. As the location of the epidural can span a wider area than a spinal, there is more latitude to place it above the tattoo sometimes. Your own nurse anesthetist or anesthesiologist may choose to do the same, or may feel it safer or more conservative to refuse the procedure if it involves transversing the tattoo. It’s a question you have to take up with the individual performing the procedure, because we each have to make judgements regarding what we feel comfortable with as being safe for the patient.