Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery

Ortéga, D.; Viviand, X.; Lorec, Anne-Marie; Gamerre, M.; Martin, Claude; Bruguerolle, Bernard

doi:10.1034/j.1399-6576.1999.430405.x

Cited by 56 publications

(22 citation statements)

References 6 publications

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“…After epidural administration, local anaesthetics showed acceptable milk-to-plasma ratios of 1.1 for lignocaine (lidocaine) and 0.34 for bupivacaine (Ortega et al, 1999) and 0.25 for ropivacaine (Matsota et al, 2009), which are considered safe (Rathmell et al, 1997). Use of epidural analgesia (local anaesthetic ± fentanyl) during labour (Chang & Heaman, 2005 Level III-3) or as PCEA after Caesarean section (Matsota et al, 2009 Level IV) did not influence neurobehavioural scores in healthy term infants.…”

Section: Other Medications Related To Pain Reliefmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Other Medications Related To Pain Reliefmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…Newborn serum concentrations were unable to be assessed due to transplacental passage of LA, but APGAR scores and 24-hour clinical examinations were normal in the study population. 9 • Opioid: The serum concentration of opioid, which is determined by the dose of spinal or epidural analgesia, is usually minuscule, if at all present. Madej et al found that after a fentanyl bolus of 100 mcg into the epidural space for elective cesarean delivery, the drug in maternal breast milk was undetectable at the time of first request for postoperative analgesics by the mother.…”

Section: A With Neuraxial Anesthesiamentioning

confidence: 99%

Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

Cobb

Liu

Valentine

et al. 2015

Transl Perioper & Pain Med

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Brief Summary:Doctors, nurses, and midwives often inform mothers to "pump and dump" their breast milk for 24 hours after receiving anesthesia to avoid passing medications to the infant. This advice, though cautious, is probably outdated. This review highlights the more recent literature regarding common anesthesia medications, their passage into breast milk, and medication effects observed in breastfed infants. We suggest continuing breastfeeding after anesthesia when the mother is awake, alert, and able to hold her infant. We recommend multiple types of medications for pain relief while minimizing sedating medications. Few medications can have sedating effects to the infant, but those medications are specifically outlined. For additional safety, anesthesia providers and patients may screen medications using the National Institute of Health' LactMed database. INTRODUCTIONThe positive impact of breastfeeding for both mothers and infants has been well established.1, 2 Given the difficulty of conducting randomized clinical trials in breastfeeding mothers and their infants however, there is a paucity of human data regarding the transfer of anesthesia and analgesia medications into breast milk. Available information remains limited to case studies, small sample observations, and animal studies, which may or may not accurately reflect conditions for lactating women. 3,4 This lack of knowledge may lead mothers who require medication to abandon nursing on their own accord or based on conservative advice from healthcare practitioners who are concerned about possible adverse effects in the infant. 5 In addition, physicians, hospitals, and even patients continue to rely on the information given by drug manufacturers concerning the use of drugs during breastfeeding, which is often restrictive or similarly contains contraindications for the lactation period. The lack of agreement among physicians, the FDA, and hospital policy has created different recommendations and practices regarding, 1) the interval between medication administration and breastfeeding, 2) when to "pump and dump", and most importantly, 3) which medications are safe. This review highlights the most recent medical literature concerning breastfeeding and the perioperative use of common medications by anesthesia providers during the intraoperative, intrapartum, postoperative and postpartum periods. 6 The review is focused only on opioid-naïve patients as evidence addressing recommendations in opioid-tolerant lactating mothers remain non-existent. Information presented in this review is written on the premise that data is limited and most medications administered in this patient population have not been rigorously screened by the FDA for safety and efficacy. EVIDENCEThe transfer of medications into breast milk depends on pharmacological properties including protein binding, lipid solubility, molecular weight, pKa, and maternal plasma level of the drug. 7 In general, medications that are highly lipid soluble, less protein-bound, of lower molecular weight, or wit...

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“…Studies evaluating IV, epidural, and dental administration of lidocaine suggest that nursing after these procedures is generally safe [18][19][20]. Nevertheless, patients may wish to consider pumping and discarding milk from the affected breast for up to 12-24 hours after core needle biopsy.…”

Section: Imaging-guided Proceduresmentioning

confidence: 99%

Breast Imaging of the Pregnant and Lactating Patient: Imaging Modalities and Pregnancy-Associated Breast Cancer

Vashi

Hooley

Butler

et al. 2013

American Journal of Roentgenology

115

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Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery

Abstract: This study documents the magnitude of excreted lidocaine, bupivacaine and PPX in breast milk, and indicates that the use of both lidocaine and bupivacaine for epidural anaesthesia is safe with regard to breast-feeding.

Cited by 56 publications

References 6 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk

Breast Imaging of the Pregnant and Lactating Patient: Imaging Modalities and Pregnancy-Associated Breast Cancer

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