Neostigmine and Glycopyrrolate for the Treatment of Post Dural Puncture Headache After Known Dural Puncture With a Tuohy Needle: A Pilot Study

What this Trial Is About

Researchers are evaluating the use of Neostigmine and Glycopyrrolate to treat post-dural puncture headache (PDPH) in postpartum women who develop this headache after an accidental dural puncture with a Tuohy needle. The study aims to reduce the number of women with PDPH who need an epidural blood patch (EBP), which is the current standard treatment but carries some risks and contraindications. This pilot study builds on earlier findings that suggested these drugs might help reduce headache severity and EBP need. In this study, women with PDPH and a pain score of 4 or higher will receive intravenous infusions of Neostigmine (20 mcg/kg) and Glycopyrrolate (4 mcg/kg) over 10 minutes. This treatment is given every 8 hours for up to three doses or until pain is reduced to a score of 3 or less. Alongside the study drugs, patients will also receive standard supportive treatments such as hydration, caffeine, acetaminophen, ibuprofen, and pain medication as needed. Participants are carefully monitored during and after infusions for vital signs and possible side effects like muscle cramps or blurred vision. Participants will be assessed daily in the hospital for headache symptoms, and pain scores will be tracked at multiple time points up to two weeks after treatment. Researchers will monitor the number of women requiring EBP within two weeks, changes in pain levels, and any adverse events. The study includes safety monitoring with frequent blood pressure checks, continuous heart and oxygen monitoring during infusions, and follow-up evaluations to understand treatment effects and safety. Participation continues until headache resolution or decision to receive EBP, with total follow-up lasting up to two weeks after intervention.

Neostigmine and Glycopyrrolate for the Treatment of Headache After Dural Puncture