Last update: Aug. 22, 2019

Mepivacaine Hydrochloride

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Topical anesthetic used for infiltrations and nerve blocks, including epidural.

Since the last update we have not found any published data on its excretion in breast milk, however, its chemical structure closely related to Bupivacaine makes it unlikely to transfer into breastmilk in significant amounts.

The pudendal block with mepivacaine was associated with delayed onset and shorter duration of the first breastfeeding and lower frequency of breastfeeding (Ransjö 2001).

There is controversy over whether drug analgesia during childbirth (epidural with local anesthetics with the addition or not of fentanyl) can affect the onset of breastfeeding, whether due to delayed lactogenesis II, or due to impairment of the infant's own competencies (French 2016, Herrera 2015, Howie 2006).

There are studies that show that with epidural anesthesia there is a greater risk of delaying the lactogenesis II period (stimulation of milk production) beyond 3 days (Herrera 2015, Lind 2014) and lower frequency and duration of breastfeeding (Thorvaldsen 2006), although they do not affect the initial weight loss of the newborn.
In some studies, the newborn appears to be at greater risk of delaying the first breastfeeding, due to having a higher body temperature and presenting irritability or drowsiness (Ransjö 2001).
This being the case, more support will be needed for breastfeeding mothers who have received analgesia ante- and intra-partum (Zuppa 2014).

But other studies do not find significant problems in the initiation and maintenance of breastfeeding due to epidural anesthesia in childbirth or caesarean section (Mahomed 2019, Xu 2019, Grant 2019, Lee 2017, Mauri 2015, Shrestha 2014, Wilson 2010, Wieczorek 2010, Goma 2008, Chen 2008, Wang 2005, Chang 2005, Radzyminski 2003, Abouleish 1978).

The onset of breastfeeding was earlier and with more frequent feeds in vaginal delivery than after caesarean section and with epidural anesthesia than with general anesthesia (Kutlucan 2014, Sener 2003).
Regarding the epidural, general anesthesia was associated less frequently with breastfeeding and exclusive breastfeeding at 6 weeks (Orbach 2018) and at 6 months (Karasu 2018).

Prolactin levels decrease less with epidural anesthesia during childbirth (Jouppila 1980).

The use of local anesthetics and regional anesthesia (spinal, epidural or peripheral block) decreases the need for opioids and other analgesics which can interfere with breastfeeding (Reece 2017).

Considering the fact that Mepivacaine readily crosses the placenta barrier and that the newborn eliminates it more slowly than the adult (Normon 2003: T ½ = 9 hours), it is safer the choice of Bupivacaine or Ropivacaine in case of prematurity or during the immediate neonatal period.


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Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

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Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Mepivacaine Hydrochloride is also known as


Mepivacaine Hydrochloride in other languages or writings:

Group

Mepivacaine Hydrochloride belongs to this group or family:

Pharmacokinetics

Variable Value Unit
Molecular weight 283 daltons
Protein Binding 78 %
pKa 7,7 -
Tmax 0,5 hours
T1/2 1,9 - 3,2 hours

References

  1. Grant GJ, Agoliati AP, Echevarria GC, Lax J. Epidural Analgesia to Facilitate Breastfeeding in a Grand Multipara. J Hum Lact. 2019 Feb;35(1):165-167. Abstract
  2. Xu Q, Wu ZF, Yang NN, Shi M, Zhu ZQ. Impact of epidural analgesia during labor on breastfeeding initiation and continuation: a retrospective study. J Matern Fetal Neonatal Med. 2019 Mar 19:1-4. Abstract
  3. Mahomed K, Wild K, Brown C, Green A. Does fentanyl epidural analgesia affect breastfeeding: A prospective cohort study. Aust N Z J Obstet Gynaecol. 2019 Apr 8. Abstract
  4. Orbach-Zinger S, Landau R, Davis A, Oved O, Caspi L, Fireman S, Fein S, Ioscovich A, Bracco D, Hoshen M, Eidelman LA. The Effect of Labor Epidural Analgesia on Breastfeeding Outcomes: A Prospective Observational Cohort Study in a Mixed-Parity Cohort. Anesth Analg. 2018 May 25. Abstract
  5. Karasu D, Yilmaz C, Ozgunay SE, Cansabuncu S, Korfali G. A comparison of the effects of general anaesthesia and spinal anaesthesia on breastfeeding. C R Acad Bulg Sci . 2018;71:993-1000. Abstract Full text (in our servers)
  6. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeeding Medicine. 2017 Full text (link to original source) Full text (in our servers)
  7. Lee AI, McCarthy RJ, Toledo P, Jones MJ, White N, Wong CA. Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial. Anesthesiology. 2017 Oct;127(4):614-624. Abstract
  8. French CA, Cong X, Chung KS. Labor Epidural Analgesia and Breastfeeding: A Systematic Review. J Hum Lact. 2016 Aug;32(3):507-20. Abstract
  9. Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C, Ocaña-Peinado FM. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery. 2015 Jun;31(6):613-6. Abstract
  10. Mauri PA, Contini NN, Giliberti S, Barretta F, Consonni D, Negri M, Di Benedetto I. Intrapartum epidural analgesia and onset of lactation: a prospective study in an Italian birth centre. Matern Child Health J. 2015 Mar;19(3):511-8. Abstract
  11. Lind JN, Perrine CG, Li R. Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation. J Hum Lact. 2014 Abstract
  12. Mepivacaine. Drug Summary. 2014 Full text (in our servers)
  13. Shrestha B, Devgan A, Sharma M. Effects of maternal epidural analgesia on the neonate - a prospective cohort study. Ital J Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  14. Kutlucan L, Seker İS, Demiraran Y, Ersoy Ö, Karagöz İ, Sezen G, Köse SA. Effects of different anesthesia protocols on lactation in the postpartum period. J Turk Ger Gynecol Assoc. 2014 Dec 1;15(4):233-8. Abstract
  15. Wilson MJ, MacArthur C, Cooper GM, Bick D, Moore PA, Shennan A; COMET Study Group UK. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia. 2010 Abstract Full text (link to original source) Full text (in our servers)
  16. Wieczorek PM, Guest S, Balki M, Shah V, Carvalho JC. Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. Int J Obstet Anesth. 2010 Jul;19(3):273-7. Abstract
  17. Goma HM, Said RN, El-Ela AM. Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi Med J. 2008 May;29(5):678-82. Abstract
  18. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006 Abstract Full text (link to original source) Full text (in our servers)
  19. Howie WO, McMullen PC. Breastfeeding problems following anesthetic administration. J Perinat Educ. 2006 Abstract Full text (link to original source) Full text (in our servers)
  20. Wang BP, Li QL, Hu YF. [Impact of epidural anesthesia during delivery on breast feeding]. Di Yi Jun Yi Da Xue Xue Bao. 2005 Abstract Full text (link to original source) Full text (in our servers)
  21. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005 Abstract
  22. Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Gynecol Obstet Invest. 2003 Abstract
  23. Mepivacaina. Ficha técnica. 2003 Full text (in our servers)
  24. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003 Abstract
  25. Ransjö-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widström AM, Uvnäs-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001 Abstract
  26. Jouppila R, Jouppila P, Moilanen K, Pakarinen A. The effect of segmental epidural analgesia on maternal prolactin during labour. Br J Obstet Gynaecol. 1980 Abstract
  27. Abouleish E, Donck AV, Meeuwis H, Taylor F. Effect of anaesthesia for delivery on the weight of infants during the first 5 days of life. Br J Anaesth. 1978 Abstract
  28. Meffin P, Long GJ, Thomas J. Clearance and metabolism of mepivacaine in the human neonate. Clin Pharmacol Ther. 1973 Abstract
  29. Lurie AO, Weiss JB. Blood concentration of mepivacaine and lidocaine in mother and baby after epidural anesthesia. Am J Obstet Gynecol. 1970 Abstract

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