UMMS Affiliation
Department of Anesthesiology and Perioperative Medicine
Publication Date
2020-08-01
Document Type
Article
Disciplines
Anesthesia and Analgesia | Anesthesiology | Health Services Administration | Infectious Disease | Nervous System Diseases | Therapeutics | Virus Diseases
Abstract
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.
Keywords
COVID 19, PDPH, epidural blood patch, post-dural puncture headache
Rights and Permissions
Copyright the American Society of Interventional Pain Physicians under a Creative Commons license (CC-BY-NC), per publisher's open access statement at https://www.painphysicianjournal.com/journals/about.
Source
Scemama P, Farah F, Mann G, Margulis R, Gritsenko K, Shaparin N. Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19. Pain Physician. 2020 Aug;23(4S):S305-S310. PMID: 32942790. View article on publisher's site
Journal/Book/Conference Title
Pain physician
Related Resources
PubMed ID
32942790
Repository Citation
Scemama P, Farah F, Mann G, Margulis R, Gritsenko K, Shaparin N. (2020). Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19. COVID-19 Publications by UMMS Authors. Retrieved from https://escholarship.umassmed.edu/covid19/118
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Included in
Anesthesia and Analgesia Commons, Anesthesiology Commons, Health Services Administration Commons, Infectious Disease Commons, Nervous System Diseases Commons, Therapeutics Commons, Virus Diseases Commons