1. 2025;28;E129-E135Effect of Tattoos on Spinal or Epidural Anesthesia: A Narrative Review
   Narrative Review
   Haixia Yang, MD, and Yali Ji, MD.

BACKGROUND: The popularity of tattoos has increased significantly, particularly among younger demographics. However, the implications of tattoos on medical procedures, such as spinal or epidural anesthesia, are not well established. There is a need to understand the potential risks and complications associated with administering anesthesia through tattooed skin.

OBJECTIVES: This narrative review aims to explore the principles of tattooing, the composition of tattoo pigments, the immune response to tattoos, the complications arising from tattoos, and the impact of tattoos on spinal or epidural anesthesia.

STUDY DESIGN: A comprehensive literature review was conducted to gather information on the interaction between tattoos and anesthesia. The review included studies that examined the effects of tattoos on anesthesia outcomes and patient safety.

SETTING: The review spans both clinical and research environments, focusing on the interactions of tattooed skin and anesthesia administration, particularly in regions where tattoos are prevalent.

METHODS: Relevant databases were searched for studies discussing the relationship between tattoos and anesthesia. The analysis included examination of tattoo pigments, immune responses, and the potential for complications during the administration of anesthesia through tattooed skin.

RESULTS: The review found that tattoos could lead to various complications, including infections, allergic reactions, and skin lesions. The presence of tattoos does not preclude the use of spinal or epidural anesthesia but may necessitate modifications in anesthetic technique. The pigments used in tattoos, especially organic compounds, can potentially cause neurotoxic reactions if introduced into the spinal canal. Additionally, tattoos may interfere with the body’s immune response, leading to localized inflammation and potential nerve injury.

LIMITATIONS: The review is limited by the scarcity of studies specifically addressing the interactions between tattoos and anesthesia. The variability in tattoo pigments and individual patient responses further complicates the establishment of standardized guidelines.

CONCLUSIONS: While tattoos present potential risks when considering spinal or epidural anesthesia, they do not absolutely contraindicate these procedures. Anesthesia providers should be aware of the possible complications and adapt their practices accordingly. These adjustments may include selecting alternative puncture sites, using caution with MRI and high-frequency electrosurgery, and obtaining detailed information about the tattoo’s pigment composition. Further research is needed to establish clear guidelines and to better understand the long-term implications of tattoos on anesthesia safety and efficacy.

KEY WORDS: Tattoo, intraspinal anesthesia, complication, anesthesia method