(no subject)

[waterspyder]

So today at work, something was brought to my attention, and it's really intriguing to me.

It's the premise that women with lower back tattoos (tramp stamps) may not be able to get epidurals in Canada because the ink gets into the spinal cord/tissue, and due to the lack of medical research, anaethesiologists are reluctant to perform them. According to the report from the Canadian Journal of Anesthesia, they're not really sure either, although some cases of neuropathy and other conditions have been reported. 

They intend to research this more since more and more women have these lower lumbar tattoos, and in the meantime, it's up to the anaesthesiologist to whether they want to give the epidural, not give them, or cut a section of skin out before giving them. 

I'd totally count this as a major con when choosing a tattoo site.

Comments

[daruba.livejournal.com]

Doctors do whatever they want anyway. That's the point. Doesn't make it right, or true, for that matter.

I read the article;

"Conclusions: There is no information in the literature about possible risks from inserting needles through tattoos during the performance of neuraxial anesthesia. This report discusses the possible implications. "

In two of the three examples they were able to find pigment free skin. What’s the statistical validity of a study of three people, two of which don’t even fit the criteria.

But it even get's better. They then go on to say that coring from just skin itself can cause tumours. Hell, by that regard NO ONE should get an epidural...

"Coring
Hollow needles, with or without a stylet, entrap tissue fragments (cores) in their bore as they pass to deeper structures. Injection through these needles may then result in this entrapped tissue being deposited in the deeper site. In 1956 Choremis et al. reported on five children who developed iatrogenic epidermoid tumours in the epidural and subarachnoid spaces following multiple spinal injections of antibiotics.3 The authors postulated that during lumbar puncture a "core" of tissue containing epidermal elements was picked up as the nonstyletted needle passed through the skin and was subsequently injected into the subarachnoid or epidural space. The cells of the core then grew into an epidermoid tumour. Since that time numerous other cases have been reported including some in adults4? and one involving spinal anesthesia in a parturient. This latter case had two lumbar punctures as a child and a third at age 33 for "diagnostic purposes". She then had a fourth for spinal anesthesia for childbirth and subsequently developed an epidermoid tumour. "

Interestingly, What I had read is that the needle for a epidural is quite tiny. But they try to account for that:

"Although nonstyletted needles have been implicated in "coring", the newer styletted spinal needles also cause coring. Campbell et al. microscopically examined the needle tips of 25-gauge Quincke and Whitacre needles for evidence of coring after failed attempts to identify the subarachnoid space.9 Tissue cores were found in 80% of the Quincke needles and 41% of the Whitacre needles. Most of the tissue was blood clot or fat. No epidermal tissue was found."

So no epidermal tissue was found. But yah, there was coring. In normal non tattood situations.

they go on to explain complications due to normal tattooing, that I guess they are implying could be exacerbated by a epidural. But who really knows, since they don't connect the two, except having them in the same report.

And then they conclude..

"Will nicking the skin prior to inserting an epidural or spinal needle as done by Campbell et al. avoid picking up tissue cores containing pigment? It would seem reasonable. Obviously the size of the nick has to be larger than the needle being inserted and should penetrate through the dermis. Whether these precautions provide adequate protection is unknown.

To date, there are no reports of complications from inserting a needle through a tattoo."

But then, it's risky, due to the normal risks associated with tissue coring..

"However, the lack of reported complications could reflect the fact that in the past fewer patients (pregnant and non-pregnant) had tattoos involving the midline of their lower back. The number of patients having neuraxial anesthesia through a pigmented tattoo would have been correspondingly small. Additionally, epidermoid tumours and arachnoiditis do not occur immediately but develop over time. It may be too early to see any long-term consequences."

con't