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Can an inflammatory reaction in the meninges, caused by spinal puncture through tattooed skin, evolve into adhesive arachnoiditis? An experimental model in rabbits
  1. Ronaldo Antonio da Silva,
  2. Isabela Leite Ferraz,
  3. Ricardo Santos Zuza,
  4. Camila Camara,
  5. Mariângela Alencar Marques,
  6. Vânia Maria de Vasconcelos Machado,
  7. Laís Helena Camacho Navarro,
  8. Guilherme Antônio Moreira de Barros and
  9. Eliana Marisa Ganem
  1. Department of Anesthesiology, Botucatu Medical School, University of São Paulo State, UNESP, São Paulo, Brazil
  1. Correspondence to Dr Ronaldo Antonio da Silva, Botucatu Medical School, University of São Paulo State, UNESP, São Paulo, Brazil; ronaldomed{at}


Background and objectives As the number of people with tattoos has been increasing, anesthesiologists are more and more faced with the decision to perform a neuraxial blockage through tattooed skin. In this study, we evaluated the possibility of puncture through tattooed skin determines acute inflammatory changes in the meninges and spinal cord and later evolve into adhesive arachnoiditis.

Method Forty-two male rabbits were randomized into 3 groups of 14: G1, spinal puncture through non-tattooed skin and saline solution injection; G2, spinal puncture through tattooed skin and saline solution injection, captive for 30 days; G3, spinal puncture through tattooed skin and saline solution injection, captive for 360 days. The animals were anesthetized and ultrasound-guided spinal puncture was performed in the intervertebral spaces between S1 – S2. During the period of captivity, the animals were clinically assessed for sensitivity and motor function. After that, they were sacrificed and the lumbosacral portion of the spinal cord was excised for histological analysis.

Results No histological changes were found on group 1. Eleven animals from group two presented with foci of perivascular lymphocytic inflammatory infiltrate in the pia mater and/or arachnoid. In Group 3, eight rabbits presented with inflammatory changes in the meninges, which were associated with thickening and/or adhesion of the pia mater and arachnoid in some cases and five rabbits presented only thickening of pia-mater.

Conclusions Spinal puncture through tattooed skin of rabbits can trigger acute inflammatory changes in the meninges and after a prolonged period of observation evolve into adhesive arachnoiditis.

  • neuraxial blocks: spinal
  • neurotoxicity
  • animal studies
  • Tattooing
  • Arachnoiditis

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  • Presented at Interim data from this work was presented at the Euroanesthesia 2018—European Society of Anesthesiology in Denmark, 2 June 2018 to 4 June 2018.

  • Contributors RAdS, ILF, and EMG contributed to the conception and design of study. RAdS, ILF, CC, and RSZ contributed to the acquisition of data. RAdS, MM, VMdM, and EMG contributed to the analysis and/or interpretation of data. RAdS, LHCN, GAMdB, and EMG drafted the manuscript. RAdS and EMG revised the manuscript.

  • Funding This work received funding from the São Paulo Research Foundation (FAPESP 2015-2/140454) and National Council for Scientific and Technological Development (CNPq 2015/054688-6).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Botucatu Medical School Ethics Committee on Animal Experiments (Certificate 1151/2015 CEUA).

  • Provenance and peer review Not commissioned; externally peer reviewed.