Last update: Aug. 22, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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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.
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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