Does Spinal Block Through Tattooed Skin Cause Histological Changes in Nervous Tissue and Meninges?: An Experimental Model in Rabbits

• Published in: Regional anesthesia and pain medicine Vol. 40; no. 5; pp. 533 - 538
• Main Authors: Ferraz, Isabela Leite, Barros, Guilherme Antônio Moreira de, Ferreira Neto, Patrícia Gomes, Solanki, Daneshivari, Marques, Mariângela Alencar, Machado, Vânia Maria de Vasconcelos, Cabral, Lucas Wynne, Lima, Rodrigo Moreira e, Vianna, Pedro Thadeu Galvão, Navarro, Lais Helena Camacho, Ganen, Eliana Marisa
• Format: Journal Article
• Language: English
• Published: England Copyright by American Society of Regional Anesthesia and Pain Medicine 01-09-2015; BMJ Publishing Group LTD
• Subjects: Anesthesia, Spinal - adverse effects; Anesthesia, Spinal - instrumentation; Animals; Injections, Spinal - adverse effects; Injections, Spinal - instrumentation; Ketamine; Male; Meninges - pathology; Models, Animal; Rabbits; Regional anesthesia; Skin - drug effects; Skin - pathology; Spinal cord; Spinal Cord - pathology; Tattooing - adverse effects
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1097/AAP.0000000000000282

BACKGROUND AND OBJECTIVESAlthough there is no documented evidence that tattoo pigments can cause neurological complications, the implications of performing neuraxial anesthesia through tattooed skin are unknown. In this study, we aimed to assess whether spinal puncture performed through tattooed skin of rabbits determines changes over the spinal cord and meninges. In addition, we sought to evaluate the presence of ink fragments entrapped in spinal needles.
METHODSThirty-six young male adult rabbits, each weighing between 3400 and 3900 g and having a spine length between 38.5 and 39 cm, were divided by lot into 3 groups as followsGI, spinal puncture through tattooed skin; GII, spinal puncture through tattooed skin and saline injection; and GIII, spinal puncture through skin free of tattoo and saline injection. After intravenous anesthesia with ketamine and xylazine, the subarachnoid space was punctured at S1-S2 under ultrasound guidance with a 22-gauge 2½ Quincke needle. Animals in GII and GIII received 5 μL/cm of spinal length (0.2 mL) of saline intrathecally. In GI, the needle tip was placed into the yellow ligament, and no solution was injected into the intrathecal space; after tattooed skin puncture, 1 mL of saline was injected through the needle over a histological slide to prepare a smear that was dyed by the Giemsa method to enable tissue identification if present. All animals remained in captivity for 21 days under medical observation and were killed by decapitation. The lumbosacral spinal cord portion was removed for histological analysis using hematoxylin-eosin stain.
RESULTSNone of the animals had impaired motor function or decreased nociception during the period of clinical observation. None of the animals from the control group (GIII) showed signs of injuries to meninges. In GII, however, 4 animals presented with signs of meningeal injury. The main histological changes observed were focal areas of perivascular lymphoplasmacyte infiltration in the pia mater and arachnoid. There was no signal of injury in neural tissue in any animal of both groups. Tissue coring containing ink pigments was noted in all GI smears from the spinal needles used to puncture the tattooed skin.
CONCLUSIONSOn the basis of the present results, intrathecal injection of saline through a needle inserted through tattooed skin is capable of producing histological changes over the meninges of rabbits. Ink fragments were entrapped inside the spinal needles, despite the presence of a stylet.