Is Lidocaine Safe in Breastfeeding

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

Compatible with breastfeeding no matter the multiple ways it can be used: anesthetic, anti-arrhythmic, or anti-epileptic drug. Excreted into breast milk in non-significant amount with no side effects on breastfed infants from treated mothers. As a topical anesthetic (dermatologic, dental-stomatologic, ophtalmotologic and otologic preparations) it has an almost nil systemic absorption. Avoid using it on the nipple, but if necessary do it after the breast feed, wipe it out and rinse with water before the next feed, An euptectic mixture with added Prilocaine (EMLA) is used for dermatologic anesthesia. There is an increased risk of Methemoglobinemia when applied on large surfaces or taken by mouth. Intrapartum anesthesia may delay the onset of phase II of Lactogenesis or milk coming-in. The American Academy of Pediatrics rates it usually compatible with Breastfeeding.

Lidocaine concentrations in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and the lidocaine is poorly absorbed by the infant. Lidocaine is not expected to cause any adverse effects in breastfed infants. No special precautions are required.[1][2][3] Lidocaine 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 and deficient design of many of the studies. Overall it appears that with good breastfeeding support epidural lidocaine with or without fentanyl or one of its derivatives has little or no adverse effect on breastfeeding success.[4][5][6][7][8] Labor pain medication may delay the onset of lactation.

Lidocaine in doses ranging from 60 to 500 mg administered to the mother by intrapleural or epidural routes during delivery had no effect on their 14 infants who were either breastfed or received their mother's breastmilk by bottle.[2] A neurology group reported using 1% lidocaine for peripheral nerve blocks in 14 nursing mothers with migraine. They reported no infant side effects and considered the procedure safe during breastfeeding.[11]

A randomized study compared three groups of women undergoing elective cesarean section who received subcutaneous infusion of 20 mL of lidocaine 1% plus epinephrine 1:100:000 at the incision site. One group received the lidocaine before incision, one group received the lidocaine after the incision, and the third received 10 mL before the incision and 10 mL after. Women in the pre-and post-incision administration group initiated breastfeeding earlier than those in the pre-incision administration (3.4 vs 4.1 hours). There was no difference between the post-incision administration group and the other groups in time to breastfeeding initiation.[12] A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.[13] An Egyptian study compared lidocaine 2% (n = 75) to lidocaine 2% plus epinephrine 1:200,000 (n = 70) as a wound infiltration following cesarean section. Patients who received epinephrine in combination with lidocaine began breastfeeding at 89 minutes following surgery compared to 132 minutes for those receiving lidocaine alone. The difference was statistically significant.[14]