Last update: June 2, 2019

Ropivacaine Hydrochloride

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Local anesthetic agent which is used for infiltration and nerve-blocking procedures included Epidural anesthesia.

It is excreted into breast milk in non-significant amount (Matsota 2009), with no side-effect observed on breastfed infants of treated mothers (Matsota 2009). There were no problems in the initiation and duration of breastfeeding (Chen 2008, Radzyminski 2003). Some authors found shorter duration of the first breastfeeding but no delay in onset or other breastfeeding problems (Gizzo 2012).

Their low oral bioavailability (due to negligible oral absorption) hinders the passage to infant plasma from ingested breastmilk (Reece 2017).

There is controversy about the effect of drug-mediated analgesia used during the child birth (e.g. epidural injection of local anesthetics plus Fentanyl or alone) on the mature milk coming in, whether by delaying the onset of Lactogenesis phase II, or, by affecting the ability of the child for sucking (French 2016, Herrera 2015, Howie 2006).

Some studies have shown that with epidural anesthesia there is a higher risk for delay of initiation of Lactogenesis phase II (milk coming in) longer than 3 post-natal days (Herrera 2015, Lind 2014) and lower frequency and duration of breastfeeding (Thorvaldsen 2006), but without effect on loss of initial weight. On other studies, the newborn infant appears to have higher risk for delay on first latch-on, higher body temperature and irritability or somnolence (Ransjö 2001). Because of the latter, it is argued that those mothers would be in need of more support on breastfeeding when they have received ante or intra partum analgesia (Zuppa 2014).

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

The onset of breastfeeding was earlier and with more frequent feedings in vaginal delivery than after cesarean and and with epidural anesthesia that with general anesthesia (Kutlucan 2014, Sener 2003).
Regarding the epidural, general anesthesia was associated with less frequent breastfeeding and exclusive breastfeeding at 6 weeks (Orbach 2018) and at 6 months (Karasu 2018).
Prolactin levels decrease less with epidural anesthesia during labor (Jouppila 1980).

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

There is consensus on the achievement of higher milk production and higher body weight increase in the neonate with an adequate pharmacological control of pain after C-section or vaginal childbirth.

Alternatives

We do not have alternatives for Ropivacaine Hydrochloride since it is relatively safe.

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.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Ropivacaine Hydrochloride is also known as


Ropivacaine Hydrochloride in other languages or writings:

Group

Ropivacaine Hydrochloride belongs to this group or family:

Tradenames

Main tradenames from several countries containing Ropivacaine Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Bioavailability baja - poor %
Molecular weight 329 daltons
Protein Binding 94 %
VD 0,58 l/Kg
pKa 8,07 -
Tmax 0,7 hours
T1/2 1,8 - 4,2 hours
M/P ratio 0,25 -
Theoretical Dose 0,035 - 0,045 mg/Kg/d
Relative Dose 1,3 - 1,4 %

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. 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
  3. 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
  4. 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)
  5. 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
  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. 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
  10. 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
  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. 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
  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. 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. 2014 Abstract
  15. Zuppa A, Alighieri G, Riccardi R, Cavani M, Iafisco A, Cota F, Romagnoli C. Epidural analgesia, neonatal care and breastfeeding. Ital J Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  16. Gizzo S, Di Gangi S, Saccardi C, Patrelli TS, Paccagnella G, Sansone L, Barbara F, D'Antona D, Nardelli GB. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med. 2012 Aug;7:262-8. Abstract
  17. 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)
  18. Pandya ST. Labour analgesia: Recent advances. Indian J Anaesth. 2010 Abstract
  19. 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
  20. Matsota PK, Markantonis SL, Fousteri MZ, Pandazi AK, Manikis DE, Christodoulopoulou TC, Loizou MM, Kostopanagiotou GG. Excretion of ropivacaine in breast milk during patient-controlled epidural analgesia after cesarean delivery. Reg Anesth Pain Med. 2009 Abstract
  21. 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
  22. Chen YM, Li Z, Wang AJ, Wang JM. [Effect of labor analgesia with ropivacaine on the lactation of paturients]. Zhonghua Fu Chan Ke Za Zhi. 2008 Jul;43(7):502-5. Chinese. Abstract
  23. 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)
  24. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005 Abstract
  25. 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)
  26. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003 Abstract
  27. 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
  28. 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
  29. McClure JH. Ropivacaine. Br J Anaesth. 1996 Abstract
  30. Lee A, Fagan D, Lamont M, Tucker GT, Halldin M, Scott DB. Disposition kinetics of ropivacaine in humans. Anesth Analg. 1989 Abstract
  31. 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
  32. 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

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