Neostigmine and Glycopyrrolate for the Treatment of Post Dural Puncture Headache After Known Dural Puncture With a Tuohy Needle: A Pilot Study
Mayo Clinic
Summary
The purpose of this study is to evaluate Neostigmine and Glycopyrrolate to treat post-dural puncture headache (PDPH) to reduce the proportion of postpartum women with a PDPH requiring epidural blood patch (EBP) who developed a PDPH after accidental dural puncture.
Description
Hypothesis: Neostigmine and glycopyrrolate will reduce the proportion of postpartum women with a PDPH requiring EBP who developed a PDPH after accidental dural puncture with a Tuohy needle. Background: The post dural puncture headache (PDPH) is a well-documented complication of dural puncture. Depending on a number of factors, the overall incidence of PDPH following dural puncture with an epidural Tuohy needle is typically around 50%, but can be as high as 70% for certain populations. The headache is characterized as frontal or occipital in nature, with a typical onset of 6-72 hours after du…
Eligibility
- Age range
- 18–54 years
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * Post-dural puncture headache (PDPH) after documented dural puncture with Tuohy needle during placement of epidural analgesia for labor and no other explanation for headache (HA). * Onset of HA within 72 hours of delivery. Exclusion Criteria: * Patient refusal. * Visual analog scale (NRS) score \< 4. * History of migraine headaches. * Asthma. * Arrhythmia. * Heart block. * Myasthenia gravis. * Inability to understand pain scores and other questionnaires. * Inability to speak English. * Contraindication to acetaminophen or NSAIDs. * Temperature \> 38.5 C. * Prior EBP don…
Interventions
- DrugNeostigmine
IV infusion 20 μg/kg over 10 minutes repeated every 8 hours for a maximum of 3 doses
- DrugGlycopyrrolate
IV infusion 4 μg/kg over 10 minutes repeated every 8 hours for a maximum of 3 doses
Location
- Mayo Clinic in RochesterRochester, Minnesota