Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19.
BACKGROUND
A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood.


OBJECTIVES
In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP).


METHODS
Literature review.


RESULTS
EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal).


LIMITATIONS
A narrative review with paucity of literature.


CONCLUSION
Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient.
['Scemama|Pascal|P|', 'Farah|Fadi|F|', 'Mann|Glen|G|', 'Margulis|Roman|R|', 'Gritsenko|Karina|K|', 'Shaparin|Naum|N|']
D000328:Adult D000073640:Betacoronavirus D017217:Blood Patch, Epidural D000086382:COVID-19 D000072700:Conservative Treatment D018352:Coronavirus Infections D005260:Female D006801:Humans D009407:Nerve Block D058873:Pandemics D011024:Pneumonia, Viral D051299:Post-Dural Puncture Headache D000086402:SARS-CoV-2 D013129:Spinal Puncture D016896:Treatment Outcome
epidural blood patch PDPH COVID 19 post dural puncture headache