From the Guidelines
Topical lidocaine is generally considered safe during pregnancy when used as directed, with limited systemic absorption minimizing fetal exposure. The use of topical anesthesia in pregnancy is addressed in the guidelines for office-based dermatologic surgery 1, which aims to facilitate the selection of the most effective means of achieving local anesthesia while minimizing the risk of adverse events. When considering the use of topical lidocaine during pregnancy, it's essential to note that the guidelines 1 emphasize the importance of using the lowest effective dose for the shortest duration necessary to minimize potential risks. Key points to consider when using topical lidocaine during pregnancy include:
- Using products with 2-5% lidocaine concentration for short-term applications
- Applying to small, limited areas of skin to reduce systemic absorption
- Avoiding application to large body surfaces or using for prolonged periods without medical supervision
- Informing healthcare providers about pregnancy before using any lidocaine products
- Monitoring for unusual symptoms after application and contacting healthcare providers promptly if concerns arise.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. The FDA drug label does not answer the question directly, but it advises to ask a health professional before use if pregnant or breast-feeding 2.
- The label does not provide explicit information on the safety of topical lidocaine during pregnancy.
- It is recommended to consult a doctor before using topical lidocaine during pregnancy.
From the Research
Topical Lidocaine Use During Pregnancy
- The use of topical lidocaine during pregnancy has been studied in various contexts, including its safety and efficacy for pain relief during perineal repair after vaginal delivery and for pessary removal and reinsertion pain reduction 3, 4, 5, 6, 7.
- According to a study published in the Journal of Drugs in Dermatology, topical dermatologic medications, including lidocaine, have little systemic absorption and are deemed safer than oral or parenteral agents, but their safety profile must be assessed cautiously due to limited available data 3.
- Another study published in Developmental Pharmacology and Therapeutics discussed the pharmacokinetics of local anesthetic agents, including lidocaine, and their placental transfer, highlighting the importance of considering fetal exposure and potential adverse effects on the fetus 4.
- A study in the European Journal of Clinical Pharmacology investigated the pharmacokinetics and transplacental transfer of lidocaine and its metabolite in parturients, finding that lidocaine administered by the perineal route presented a shorter time to maximum concentration compared to peridural administration, and demonstrating placental transfer of lidocaine at ratios of about 50% at the time of delivery 5.
- A systematic review and meta-analysis published in The Journal of Maternal-Fetal & Neonatal Medicine compared the efficacy of lidocaine-prilocaine cream versus local infiltration anesthesia in pain relief during repair of perineal trauma after vaginal delivery, suggesting that topical lidocaine-prilocaine cream gives comparable results in reducing pain during perineal repair 6.
- A randomized clinical trial published in the American Journal of Obstetrics and Gynecology evaluated the effect of lidocaine HCl 2% jelly versus lubricating jelly on pain at the time of office pessary removal and reinsertion, finding no significant difference in pain reduction between the two groups, despite a high percentage of participants reporting a desire for numbing jelly at future pessary examinations 7.