Is it safe to use lidocaine (local anesthetic) on nipples for pain relief before breastfeeding?

Lidocaine Safety for Nipple Pain Before Breastfeeding

Local anesthetics like lidocaine can be safely used on nipples for pain relief before breastfeeding with no need to interrupt breastfeeding afterward. 1, 2

Safety Profile of Lidocaine During Breastfeeding

• Local anesthetics, including lidocaine, are lipid-soluble amino amide compounds that may be secreted in small amounts in breast milk, but there is no evidence of harm to breastfeeding infants 1
• The Association of Anaesthetists explicitly states that local anesthetics can be used in lactating women with no need to interrupt breastfeeding 1
• No waiting period is required before resuming breastfeeding after lidocaine administration 2

FDA Labeling Considerations

• The FDA labeling for topical lidocaine advises pregnant or breastfeeding women to consult a healthcare professional before use, but does not contraindicate its use 3
• The label cautions against using on large areas of the body or on cut, irritated, or swollen skin, which is relevant when considering application to damaged nipples 3

Clinical Application for Nipple Pain

• Nipple pain is one of the most common reasons for consultation regarding breastfeeding difficulties (36% of cases in one study) and a frequent cause of early weaning 4
• The most common causes of nipple pain include incorrect positioning and attachment, tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm 4
• When using lidocaine for nipple pain:
  • Apply sparingly to the affected area
  • Allow sufficient time for the medication to take effect before breastfeeding
  • Wipe the nipple gently before breastfeeding to minimize infant exposure 2

Alternative Approaches to Consider

• Correction of positioning and attachment is the first-line approach for nipple pain 4, 5
• Other non-pharmacological interventions that may be considered include:
  • Expressed breast milk application (shown in some studies to be as effective as lanolin) 6
  • Lanolin cream (commonly used but with mixed evidence of effectiveness) 6, 7
  • Breast shells for severely damaged nipples 7

Important Considerations and Precautions

• Unlike some medications that require caution during breastfeeding, local anesthetics do not require special monitoring of the infant 2
• For most women, nipple pain naturally reduces to mild levels after approximately 7-10 days postpartum, regardless of the treatment used 6
• If using topical lidocaine, monitor for:
  • Signs of irritation or allergic reaction
  • Transient burning sensation upon application (which generally disappears in several days) 3
  • Discontinue use if condition worsens or irritation develops 3

Treatment Algorithm for Nipple Pain in Breastfeeding

1. First assess and correct positioning and latch issues 4, 5
2. For persistent pain despite corrected technique:
   • Apply expressed breast milk after feedings 6
   • Consider lanolin if expressed milk is insufficient 7
3. For severe pain that interferes with breastfeeding:
   • Apply topical lidocaine 10-15 minutes before feeding 2
   • Gently wipe nipples before feeding to minimize infant exposure 2
   • Continue addressing underlying causes of pain 4
4. If pain persists or worsens, evaluate for infection or other complications requiring specific treatment 4