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.
Key words: COVID-19; PDPH; Epidural Blood Patch; Post-dural Puncture Headache
Highlights
Patients with hip fracture and COVID-19 infection may have higher combined morbidity and mortality
Universal testing with high level of clinical judgment should be used
Appropriate timing of surgery vs non-surgical approach should be decided based on risk and severity of COVID-19 and underlying medical condition
Universal contact and droplet as well as aerosol precautions, when needed, should be utilized
Optimal surgery and anesthesia techniques should be chosen, with regional preferred over general anesthesia
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