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Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19

Pascal Scemama1, Fadi Farah2, Glen Mann3

  • 1University of Massachusetts Medical School, Worcester, MA.

Pain Physician
|September 18, 2020
PubMed

Insights

Managing post-dural puncture headache (PDPH) in COVID-19 patients requires careful consideration of epidural blood patch (EBP) risks. Alternative treatments and interventions should be explored due to potential complications in these patients.

Area of Science:

  • Anesthesiology
  • Infectious Diseases
  • Neurology

Background:

  • Concerns exist regarding epidural blood patch (EBP) safety in COVID-19 patients, including potential viral seeding in the CNS.
  • COVID-19 associated hypercoagulable state may affect anticoagulant metabolism, posing risks for EBP procedures.
  • Provider safety, patient positioning, and imaging guidance are critical factors in EBP for COVID-19 patients.

Purpose of the Study:

  • To address the management of post-dural puncture headache (PDPH) specifically in patients who have tested positive for COVID-19.
  • To evaluate the specific considerations and risks associated with performing an epidural blood patch (EBP) in COVID-19 positive individuals.

Main Methods:

  • A literature review was conducted to synthesize current knowledge.
  • The review focused on the risks and benefits of EBP in the context of COVID-19.

Main Results:

  • Epidural blood patch (EBP) is typically a second-line treatment for PDPH after conservative measures fail.
  • Due to heightened risks in COVID-19 patients, alternative pharmacological treatments like theophyllines and cosyntropin warrant consideration.
  • Non-EBP interventions such as occipital nerve blocks and sphenopalatine ganglion blocks may be viable alternatives.

Conclusions:

  • The risk-benefit analysis for performing EBP in COVID-19 patients may evolve with effective treatments, vaccines, and a better understanding of viral pathophysiology.
  • Further research is needed to establish definitive guidelines for PDPH management in COVID-19 patients.
Abstract

Keywords:
COVID 19PDPHepidural blood patchpost dural puncture headache

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