Use of Lidocaine with Epinephrine During Breastfeeding
Lidocaine with epinephrine can be safely used during breastfeeding with no need to interrupt nursing, and breastfeeding can be resumed immediately after the procedure. 1
Safety Profile
Both lidocaine and epinephrine are compatible with breastfeeding when used in small amounts for local anesthesia. The Association of Anaesthetists explicitly states that local anesthetics can be used in lactating women with no need to interrupt breastfeeding. 1
Key Evidence Supporting Safety:
No waiting period is required before resuming breastfeeding after lidocaine administration. 1
Research demonstrates that while lidocaine and its metabolite (MEGX) are excreted into breast milk, the amounts transferred are clinically insignificant and safe for the nursing infant. 2, 3
Studies of epidural anesthesia with both lidocaine and bupivacaine showed no adverse reactions in breastfed newborns, with excellent APGAR scores and normal clinical examinations at 24 hours. 2
Dental procedures using lidocaine (3.6-7.2 mL of 2% lidocaine) resulted in calculated daily infant doses of only 73.41 ± 38.94 μg/L/day, which is well below any threshold for concern. 3
Effect of Epinephrine Addition
The addition of epinephrine to lidocaine actually enhances safety during breastfeeding by limiting systemic absorption. 4
Epinephrine causes local vasoconstriction, which limits maternal blood levels and reduces placental/systemic transfer of lidocaine. 4
The American Academy of Dermatology guidelines support the use of epinephrine with local anesthesia in pregnant and nursing women when used in small amounts. 4
Standard concentrations (1:100,000 to 1:200,000) are safe and effective for dermatologic and dental procedures. 4
Clinical Recommendations
Resume breastfeeding immediately after the procedure without any pumping and discarding of milk. 1
No special monitoring of the infant is required, unlike some other medications used during lactation. 1
Use the lowest effective concentration of epinephrine (typically 1:100,000 or 1:200,000) to provide adequate anesthesia and hemostasis. 4
Common Pitfalls to Avoid
Do not advise mothers to "pump and dump" after lidocaine with epinephrine administration—this is unnecessary and may discourage breastfeeding. 1
Do not confuse this with pregnancy guidelines, where the recommendation is more conservative (postpone elective procedures until after delivery). 4 During lactation, the safety profile is well-established and more permissive.
Do not withhold necessary procedures due to unfounded concerns about breastfeeding safety—the evidence clearly supports continuation of nursing. 2, 3