Is Bupivacaine safe while breastfeeding?

Effects on the breastfed infant

Bupivacaine administered to the mother by the epidural route for labor analgesia had no apparent adverse effect on 13 breastfed infants.[ 9 ] Thirty patients who underwent cesarean section received a bilateral transverses abdominus plane block using of a mixture of 52 mg bupivacaine hydrochloride 0.25% and 266 mg liposomal bupivacaine 1.3%. Two of the infants had transient tachypnea, but causality could not be determined. None of the infants required hospital readmission during the 14-day follow-up period.[ 11 ]

Effects on milk supply

Thirty women who delivered by cesarean section received either spinal anesthesia (not defined) alone (n = 15) or spinal anesthesia plus bupivacaine (n = 15) by extradural infusion after clamping the umbilical cord. A bupivacaine bolus of 12.5 mg was followed by a continuous infusion of 17.5 mg/hour for 3 days postpartum. Patients who received bupivacaine had better pain relief as indicated by lower pain scores and a lower consumption of supplemental diclofenac for pain. Bupivacaine-treated patients also produced more milk per day than the untreated women, a difference that was statistically significant from day 3 to the end of the study on day 11 postpartum. The authors concluded that improved pain relief improved breastfeeding performance.[ 12 ] Twenty women who delivered by cesarean section received either bupivacaine alone or bupivacaine plus buprenorphine by extradural infusion after clamping the umbilical cord. A bupivacaine bolus of 12.5 mg was followed by a continuous infusion of 17.5 mg/hour for 3 days. The buprenorphine was given as a bolus of 200 mcg followed by 8.4 mcg/hour for 3 days. Patients started breastfeeding as soon as they were able to sit up. Both the amount of milk fed and infant weight increased in both groups over the first 10 days postpartum; however, the increases were greater in those who received bupivacaine alone.[ 13 ] A prospective cohort study compared women who received no analgesia (n = 63) to women who received continuous epidural analgesia with fentanyl and either bupivacaine 0.05 to 0.1% (n = 39) or ropivacaine (n = 13) during labor and delivery. The total dosage of bupivacaine was 31 to 62 mg and the average total infusion time from start to delivery was 219 minutes. The study found no differences between the groups in breastfeeding effectiveness or infant neurobehavioral status at 8 to 12 hours postpartum or the number exclusively or partially breastfeeding at 4 weeks postpartum.[ 14 ] A randomized, prospective study measured i

Levels in milk

Maternal Levels. Bupivacaine milk levels were measured in 5 women who were given epidural bupivacaine analgesia (dosage not stated) for vaginal delivery. Bupivacaine was undetectable ( 20 mcg/L) in all samples taken at 2, 8, 24 and 48 hours postpartum.[ 7 ] One woman received intrapleural bupivacaine 50 mg, followed in 1 hour by a continuous infusion of 25 mg/hour for 5 days for operative and postoperative analgesia. Four milk samples were taken during the infusion. The milk bupivacaine level was 400 mcg/L at 6 hours after the bolus dose and approximately 200 mcg/L at 24, 48 and 72 hours after the bolus dose.[ 8 ] Twenty-seven women received epidural lidocaine 2% and bupivacaine 0.5% for pain control during cesarean delivery. Bupivacaine dosage averaged 82 mg (range 25 to 168 mg). Average milk bupivacaine concentrations were 90 mcg/L at 2 hours after delivery, 60 mcg/L at 4 hours after delivery and 40 mcg/L at 12 hours after delivery.[ 9 ] Twenty women undergoing cesarean section deliveries with epidural anesthesia were randomized to receive either bupivacaine 0.5% (n = 10) or levobupivacaine 0.5% (n = 10) in a single-blinded study. The drugs were given as 0.5 mL (2.5 mg) boluses as needed up to 150 mg (mean 82.5 mg). Blood and milk samples were obtained before and 0.5, 1, 2, 6, 12 and 24 hours after administration of the drugs. Bupivacaine was detected in breastmilk 30 minutes after administration, with the peak milk concentration of about 0.2 mg/L occurring at about 2 hours after administration. Levobupivacaine was almost at baseline level by 7 hours and absent from milk ( 5 mcg/L) by 24 hours after the dose. The passage of levobupivacaine into breastmilk was virtually identical.[ 10 ] Thirty patients who underwent cesarean section received a bilateral transverses abdominus plane block using of a mixture of 52 mg bupivacaine hydrochloride 0.25% and 266 mg liposomal bupivacaine 1.3%. Simultaneous blood and milk samples were collected at either 2, 12 and 48 hours af

Alternatives LactMed lists

• Lidocaine
• Ropivacaine