Is Bupivacaine compatible with breastfeeding? Do we have alternatives for Bupivacaine?

Bupivacaine

January 10, 2015 (Very Low Risk)

Local anesthetic agent which is used for infiltration and nerve-blocking procedures included Epidural anesthesia.

It is excreted into breast milk in non-significant amount, with no side-effect observed on breastfed infants of treated mothers. Plasma levels in those infant were undetectable.

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 is 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.

Alternatives

We do not have alternatives for Bupivacaine since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • ブピバカイン
  • بوبيفاكائين
  • Бупивакаин
  • 布比卡因

Drug trade names

References

  1. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeeding Medicine. 2017 Full text (link to original source) Full text (in our servers)
  2. Lind JN, Perrine CG, Li R. Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation. J Hum Lact. 2014Abstract
  3. Bolat E, Bestas A, Bayar MK, Ozcan S, Erhan OL, Ustundag B. Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery. Int J Obstet Anesth. 2014Abstract
  4. Zuppa A, Alighieri G, Riccardi R, Cavani M, Iafisco A, Cota F, Romagnoli C. Epidural analgesia, neonatal care and breastfeeding. Ital J Pediatr. 2014Abstract Full text (link to original source) Full text (in our servers)
  5. Shrestha B, Devgan A, Sharma M. Effects of maternal epidural analgesia on the neonate - a prospective cohort study. Ital J Pediatr. 2014Abstract Full text (link to original source) Full text (in our servers)
  6. Wieczorek PM, Guest S, Balki M, Shah V, Carvalho JC. Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. Int J Obstet Anesth. 2010Abstract
  7. Wilson MJ, MacArthur C, Cooper GM, Bick D, Moore PA, Shennan A; COMET Study Group UK. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia. 2010Abstract Full text (link to original source) Full text (in our servers)
  8. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006Abstract Full text (link to original source) Full text (in our servers)
  9. Howie WO, McMullen PC. Breastfeeding problems following anesthetic administration. J Perinat Educ. 2006Abstract Full text (link to original source) Full text (in our servers)
  10. Wang BP, Li QL, Hu YF. [Impact of epidural anesthesia during delivery on breast feeding]. Di Yi Jun Yi Da Xue Xue Bao. 2005Abstract Full text (link to original source) Full text (in our servers)
  11. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005Abstract
  12. Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Gynecol Obstet Invest. 2003Abstract
  13. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003Abstract
  14. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  15. Ransjö-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widström AM, Uvnäs-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001Abstract
  16. Ortega D, Viviand X, Lorec AM, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999Abstract
  17. Hirose M, Hosokawa T, Tanaka Y. Extradural buprenorphine suppresses breast feeding after caesarean section. Br J Anaesth. 1997Abstract Full text (link to original source) Full text (in our servers)
  18. Hirose M, Hara Y, Hosokawa T, Tanaka Y. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesth Analg. 1996Abstract
  19. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993Abstract Full text (link to original source) Full text (in our servers)
  20. Nau H. Clinical pharmacokinetics in pregnancy and perinatology. I. Placental transfer and fetal side effects of local anaesthetic agents. Dev Pharmacol Ther. 1985Abstract
  21. Jouppila R, Jouppila P, Moilanen K, Pakarinen A. The effect of segmental epidural analgesia on maternal prolactin during labour. Br J Obstet Gynaecol. 1980Abstract
  22. Abouleish E, Donck AV, Meeuwis H, Taylor F. Effect of anaesthesia for delivery on the weight of infants during the first 5 days of life. Br J Anaesth. 1978Abstract