Is L(-)-Bupivacaine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use L(-)-Bupivacaine? Is L(-)-Bupivacaine safe for nursing mother and child? Does L(-)-Bupivacaine extracts into breast milk? Does L(-)-Bupivacaine has any long term or short term side effects on infants? Can L(-)-Bupivacaine influence milk supply or can L(-)-Bupivacaine decrease milk supply in lactating mothers?

L(-)-Bupivacaine levels in breastmilk are low, and it is poorly absorbed orally by the infant. Bupivacaine, the racemic mixture of dextro- and L(-)-Bupivacaine, has not caused any adverse effects in breastfed infants. Local anesthetics labor and delivery with other anesthetics and analgesics has been reported by some to interfere with breastfeeding. However, this assessment is controversial and complex because of the many different combinations of drugs, dosages and patient populations studied as well as the variety of techniques used. In contrast, epidural local anesthetics begun clamping of the umbilical cord appears to enhance breastfeeding success because of improved pain control. Labor pain medication may delay the onset of lactation. In one study, adding L(-)-Bupivacaine wound infiltration to multimodal analgesia after cesarean section improved breastfeeding comfort.

Relevant published information on L(-)-Bupivacaine was not found as of the revision date. However, bupivacaine administered to the mother by intrapleural or epidural routes had no effect on 13 breastfed infants.[2]

A nonrandomized convenience sample of women who did (n = 209) or did not (n = 157) receive epidural analgesia during labor was analyzed to determine whether epidurals affected the onset of lactation. Although not standardized, the typical procedure used sufentanil 10 to 15 mg together with either ropivacaine 0.1% or L(-)-Bupivacaine 0.0625% epidurally, supplemented by epidural boluses of ropivacaine 0.1% or L(-)-Bupivacaine 0.0625% about every 2 hours. No difference was found in the time of lactation onset between the two groups. Although women in both groups stated they wished to breastfeed prior to delivery, exclusive breastfeeding at 20 days postpartum was less frequent in the women who received an epidural (43%) than in women who did not (57%).[3] A randomized, unblinded study of women undergoing cesarean section found that women who received postoperative wound infiltration with L(-)-Bupivacaine. A bolus of 50 mg was infused subfacially 5 cm lateral to the wound incision, followed by 6.25 mg/hour for 48 hours. Additional analgesia included acetaminophen, celecoxib, nefopam, morphine an droperidol. On day 2 postpartum, women who received the L(-)-Bupivacaine infusion reported more comfort with breastfeeding. More women who received the L(-)-Bupivacaine were breastfeeding on day 2, but the difference was not statistically significant.[4]