Is Mepivacaine Safe in Breastfeeding

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

Local anesthetic agent which is used for infiltration and nerve-blocking procedures included Epidural anesthesia. At latest update, published data concerning excretion into breast milk were not found. However, because its chemical structure is closely related to Bupivacaine, it is expected to occur in a non-significant level. There is controversy about the effect of drug-mediated analgesia used during the child birth (e.g. epidural injection of local anesthetics plus Fentanyl or alone) on the mature milk coming in, whether by delaying the onset of Lactogenesis phase II, or, by affecting the ability of the child for sucking. Some studies have shown a higher risk for delay of initiation of Lactogenesis phase II (milk coming in) longer than 3 post-natal days, but without effect on loss of initial weight. On other studies, the newborn infant appears to have higher risk for delay on first latch-on, higher body temperature and irritability or somnolence. Because of the latter, it is argued that those mothers would be in need of more support on breastfeeding when they have received ante or intra partum analgesia. However, other authors have failed to find the same results. There consensus on the achievement of higher milk production and higher body weight increase in the neonate with an adequate pharmacological control of pain after C-section or vaginal childbirth. Considering the fact that Mepivacaine readily crosses the placenta barrier, with a elimination-time period that is slower than adults (T ½ = 9 hours), it is safer the choice of Bupivacaine in case of prematurity or during the immediate neonatal period.

No information is available on the use of mepivacaine during breastfeeding. Based on the low excretion of other local anesthetics into breastmilk, a single dose of mepivacaine during breastfeeding is unlikely to adversely affect the breastfed infant. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Mepivacaine given during labor as a local anesthetic to the mother has been reported to interfere with initial nursing behavior of some infants, but not weight gain during the first 5 days postpartum. Labor pain medication may delay the onset of lactation. More study is required to clarify the effect of mepivacaine during labor on breastfeeding outcome.

In a study that compared extradural administration of mepivacaine, bupivacaine and lidocaine for analgesia during normal childbirth, no differences were found in weight changes over the first 5 days after delivery among the breastfed infants of the 3 groups. Overall weight gain was within normal limits for all groups.[1] Of 6 infants whose mothers received a pudendal block with mepivacaine within the hour before delivery, 4 took longer to begin nursing behavior and nursed less initially than 10 infants whose mothers received no anesthesia during labor. The long-term consequences of these differences were not reported.[2] 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.[3]