Is Levobupivacaine safe while breastfeeding?

Effects on the breastfed infant

Relevant published information on levobupivacaine 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.[ 8 ]

Effects on milk supply

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 levobupivacaine 0.0625% epidurally, supplemented by epidural boluses of ropivacaine 0.1% or levobupivacaine 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%).[ 9 ] A randomized, unblinded study of women undergoing cesarean section found that women who received postoperative wound infiltration with levobupivacaine. A bolus of 50 mg was infused subfascially 5 cm lateral to the wound incision, followed by 6.25 mg/hour for 48 hours. Additional analgesia included acetaminophen, celecoxib, nefopam, morphine and droperidol. On day 2 postpartum, women who received the levobupivacaine infusion reported more comfort with breastfeeding. More women who received the levobupivacaine were breastfeeding on day 2, but the difference was not statistically significant.[ 10 ] A retrospective medical record study in China compared women who received patient-controlled epidural analgesia during labor (n = 527) to those who did not (n = 395). Epidural analgesia included 0.1% levobupivacaine and 5 mg of sufentanil in 10 mL of saline. All women completed a questionnaire regarding their breastfeeding experience at 6 months postpartum. There were no statistically significant differences between the groups in the proportion who initiated breastfeeding within 1 hour after birth or who exclusively or partially breastfed their infants at 1, 3, or 6 months postpartum.[ 11 ]

Levels in milk

Maternal Levels. Twenty women undergoing cesarean section deliveries with epidural anesthesia were randomized to receive either levobupivacaine 0.5% (n = 10) or bupivacaine 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 80 mg). Blood and milk samples were obtained before and 0.5, 1, 2, 6, 12 and 24 hours after administration of the drugs. Levobupivacaine was detected in breastmilk 30 minutes after administration, with the peak milk concentration of about 0.25 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 racemic bupivacaine into breastmilk was virtually identical.[ 7 ] Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Lidocaine
• Ropivacaine