The Safety of Local Anesthesia for the Lactating Parent
by Anne Eglash MD, IBCLC, FABM
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.
What else? Check the question!
- Benzocaine, whether used as a teething gel or for pain in other areas, should not be used in infants under 2 years of age due to risk of cyanosis, also known as methemoglobinemia.
- Cocaine, when used for anesthesia in the nose, is not compatible with lactation.
- Injectable anesthetics used for epidural anesthesia during childbirth produces measurable amounts in colostrum.
See the Answer
I wish we could tell the whole world to stop advising lactating parents to pump and dump when they have minor procedures done.
The information provided by Dr. Anderson reassures us that lactating individuals undergoing procedures with local/injectable anesthesia should continue to breast/chestfeed or provide expressed human milk without dumping their milk. Although anesthetic agents used for epidurals reaches measurable levels in colostrum, the levels are still considered low.
This information reminds us that some anesthetics can cause methemoglobinemia, and even adults receiving these substances can experience this, not just infants who are under 2. Methemoglobinemia is a condition where the normal oxygen-carrying hemoglobin is altered, causing lack of adequate oxygen to bodily tissues, leading to cyanosis (blue lips, hands and feet). This is a medical emergency.
Even though it is safe for the lactating parent to use lidocaine on their skin, or a benzocaine product in their mouth for pain, it is not necessarily safe for these products to be used directly on infants such as on the skin, in the mouth, or around the perianal region.