Bupivacaine Safety During Breastfeeding
Bupivacaine is safe to use during breastfeeding with no need to interrupt breastfeeding after administration. 1, 2
Evidence for Safety
- Local anesthetics, including bupivacaine, can be safely used in breastfeeding mothers with no requirement to interrupt breastfeeding, as explicitly stated by the Association of Anaesthetists 1, 2
- Bupivacaine is excreted in breast milk but in minimal amounts that pose negligible risk to healthy, term infants 3, 4
- The milk/serum ratio for bupivacaine is approximately 0.34, indicating limited transfer into breast milk compared to maternal plasma levels 3
- Relative neonatal dosage of bupivacaine through breast milk is less than 1% of the maternal dose, which is well below the 10% threshold considered to be of clinical concern 4
Pharmacokinetic Considerations
- After administration, bupivacaine concentrations in breast milk peak at around 6 hours (mean 58 ng/mL) and then steadily decline to low levels (mean 5.2 ng/mL) by 96 hours 4
- Studies examining bupivacaine transfer into breast milk after epidural anesthesia for cesarean delivery have not revealed any adverse reactions in newborns related to the excretion of local anesthetics into breast milk 3
- Even with liposomal bupivacaine formulations, which provide extended release, the relative infant exposure remains minimal and clinically insignificant 4
Clinical Recommendations
- No waiting period is required before resuming breastfeeding after bupivacaine administration 1, 2
- Bupivacaine can be safely used for various procedures in breastfeeding women, including epidural anesthesia, nerve blocks, and local infiltration 1, 3, 4
- Most commonly used drugs, including local anesthetics like bupivacaine, deliver doses via milk that are generally small and much less than known safe doses given directly to neonates and infants 5
Alternative Options
- If analgesia is needed, multimodal approaches including non-opioid drugs should be encouraged, as paracetamol (acetaminophen) and NSAIDs are also compatible with breastfeeding 1
- For muscle spasm and pain, non-pharmacological approaches like physical therapy and heat/cold therapy are considered safe alternatives for breastfeeding women 6
Potential Concerns and Monitoring
- According to the FDA drug label, bupivacaine has been reported to be excreted in human milk, but the risk of adverse reactions in nursing infants is minimal 7
- No adverse effects on breastfed infants have been documented in clinical studies examining bupivacaine use during lactation 3, 4
- Unlike some medications that require caution during breastfeeding, local anesthetics including bupivacaine do not require special monitoring of the infant 2
In conclusion, the available evidence strongly supports that bupivacaine can be safely used in breastfeeding women without interruption of breastfeeding or special precautions.