My office often receives phone calls from patients, physicians, nurses, dentists, and others regarding the safety of breastfeeding or providing expressed human milk when the lactating parent undergoes a minor procedure such as a mole removal or dental work.

Dr. Philip Anderson addresses these concerns in his recent article ‘Local Anesthesia and Breastfeeding’ published online in the Breastfeeding Medicine Journal, December 2020. Topical anesthetics are those used on the skin, the lining of the mouth, or in other orifices such as the vagina or the anal region. For example, lidocaine patches are used for muscle pain or back pain. Benzocaine is often used on the skin for burns, or in the mouth for sores, and for vaginal or anal discomfort. Pramoxine is often used for hemorrhoids.

As long as the topical anesthetics are not placed on the nipples or other areas when the infant has direct contact to the medication, these topical agents are generally considered safe during lactation, and not expected to reach significant levels in human milk.

There are several anesthetics used for injection for all sorts of procedures such as skin biopsies, lacerations, dental work, intravenously for pain, or into body cavities such as in the chest. These include lidocaine, bupivacaine, mepivacaine, ropivacaine and prilocaine. The 2 injectable anesthetics that have been studied the most are bupivacaine and lidocaine, and have been found to be safe. Prilocaine can cause methemoglobinemia, and it is recommended to not use this for injectable anesthesia for a lactating individual.

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