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Small amounts of lidocaine are excreted into breast milk (24). A 37-year-old, lactating woman was treated with intravenous lidocaine for acute onset ventricular arrhythmia secondary to chronic mitral valve prolapse. The woman had been nursing her 10-month-old infant up to the time of treatment. She was treated with lidocaine, 75 mg over 1 minute, followed by a continuous infusion of 2 mg/minute (23 g/kg/minute). A second 50-mg dose was given 5 minutes after the first bolus dose. The woman's serum lidocaine level 5 hours after initiation of therapy was 2 g/mL. The drug concentration in a milk sample, obtained 2 hours later when therapy was stopped, was 0.8 g/mL (40% of maternal serum). Although the infant was not allowed to nurse during and immediately following the mother's therapy, the potential for harm of the infant from exposure to lidocaine in breast milk is probably very low. The American Academy of Pediatrics considers lidocaine to be compatible with breast feeding (25).
Quote:
25. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:13750.
Lidocaine is excreted into human milk. The effects in the nursing infant are unknown. The manufacturer recommends that caution be used when administering lidocaine topical to nursing women.
J Pediatr Gastroenterol Nutr. 2001 Feb;32(2):142-4. Could local anesthesia while breast-feeding be harmful to infants?
Giuliani M, Grossi GB, Pileri M, Lajolo C, Casparrini G.
BACKGROUND: Few studies have been carried out on the levels and possible toxicity of local anesthetics in breast milk after parenteral administration. The purpose of this study is to determine the amount of lidocaine and its metabolite monoethyl-glycinexylidide (MEGX) in breast milk after local anesthesia during dental procedures. METHODS: The study population consisted of seven nursing mothers (age, 23-39 years) who received 3.6 to 7.2 mL 2% lidocaine without adrenaline. Blood and milk concentrations of lidocaine and its metabolite MEGX were assayed using high-performance liquid chromatography. The milk-to-plasma ratio and the possible daily doses in infants for both lidocaine and MEGX were calculated. RESULTS: The lidocaine concentration in maternal plasma 2 hours after injection was 347.6 +/- 221.8 microg/L, the lidocaine concentration in maternal milk ranged from 120.5 +/- 54.1 microg/L (3 hours after injection) to 58.3 +/- 22.8 microg/L (6 hours after injection), the MEGX concentration in maternal plasma 2 hours after injection was 58.9 +/- 30.3 microg/L, and the MEGX concentration in maternal milk ranged from 97.5 +/- 39.6 microg/L (3 hours after injection) to 52.7 +/- 23.8 microg/L (6 hours after injection). According to these data and considering an intake of 90 mL breast milk every 3 hours, the daily infant dosages of lidocaine and MEGX were 73.41 +/- 38.94 microg/L/day and 66.1 +/- 28.5 microg/L/day respectively. CONCLUSIONS: This study suggests that even if a nursing mother undergoes dental treatment with local anesthesia using lidocaine without adrenaline, she can safely continue breastfeeding.
It's essentially still the mother's choice after your guidance is given and will depend on many factors such as age of bub etc. Look at the drug's half life and get further advice from breastfeeeding associations who are used to these types of questions. Otherwise, I would suggest: if in doubt, throw it out! Cheers!
how desperate are you to use xylocaine.....given all the hype and scares around ill effects on the child/foetus of smoking, pate and other such daily occurences I would personally say no way no matter what the evidence says. Just remember any problems and they will be looking for some one to blame. YOU!
Just say no.
Unless they are a dedicated breast feeder until the child is .....well there are all sorts out there! and cannot walk and are prepared to sign a disclaimer and you give them a comprehensive detailed legal document to sign....and did they really understand you? wittnessed and counter wittnessed .....JUST SAY NO and see you when you've finished lactating!
how desperate are you to use xylocaine.....given all the hype and scares around ill effects on the child/foetus of smoking, pate and other such daily occurences I would personally say no way no matter what the evidence says. Just remember any problems and they will be looking for some one to blame. YOU!
Just say no.
Unless they are a dedicated breast feeder until the child is .....well there are all sorts out there! and cannot walk and are prepared to sign a disclaimer and you give them a comprehensive detailed legal document to sign....and did they really understand you? wittnessed and counter wittnessed .....JUST SAY NO and see you when you've finished lactating!
If the mother/patient had a badly infected ingrown nail that needed to be avulsed, then I would do it since the risk to the nursing child from Lidocaine is lower than the risk from cellulitis to the mother.
Hi
I would agree with Nat, it's about assessing the risk. We had a similar question a few months ago when some staff were worried about administering mepivicaine (for nail surgery), to mothers who were breast feeding.
We took advice from our pharmacy department and they produced the same type of evidence as in the previous posts and concluded that the risk was minimal.
All the studies they quoted were on lidocaine and those that suggested a small risk might exist, concerned the use of intravenous lidocaine.
__________________
Michael Gates,
Podiatrist,
Inverness ,
Highlands
Scotland
I would and have given LA to nursing mothers, I would not however phenolise. I researched this about 20yrs ago and found a link to sudden infant death.
I would and have given LA to nursing mothers, I would not however phenolise. I researched this about 20yrs ago and found a link to sudden infant death.
Nina
I would love to see that link.....because I think it is physically impossible to issue a localised irritant to a mother and have it manifest in a child months/years later...
I am happy to be proven wrong.
Then again casual causation is alive and well isn't it. Maybe it wasn't the phenol maybe it was sitting in the waiting room and looking at the bad practice wallpaper that led to SIDS in the supposed "research" you quote. Just a thought!
In reference to the original question - its lignocaine - show me a study that says its toxic during pregnancy. THere is documentation which states effects are unknown - but nothing saying its not safe. Common sense prevails - risk VS benefit, and at this point there is no real risk.
I couldn't google or search on Pod areana in those days, I can only think I gleaned the info from the then current copy of the BNF (British National Formulary).
I take your point about correlation is not causation but when a baby dies and you find a potential link you make sure it can't happen again. I too wouldn't have thought that enough phenol could be absorbed but how much is enough?
When administering a drug to a nursing mother I ask myself whether (in the correct dose) I would administer it to the child?
I wonder how many nursing mothers had an epidural during birth. A one time shot of 5cc in a toe is probably going to be less than the amount of the epidural. Ultimately, it should be the patients informed choice. The pediatrician organization sited above think it is ok, people get epidurals for birth versus the pain of removing an ingrown toenail without anesthesia. Give them the choice.
Eric
The Following User Says Thank You to efuller For This Useful Post:
I couldn't google or search on Pod areana in those days, I can only think I gleaned the info from the then current copy of the BNF (British National Formulary).
I take your point about correlation is not causation but when a baby dies and you find a potential link you make sure it can't happen again. I too wouldn't have thought that enough phenol could be absorbed but how much is enough?
When administering a drug to a nursing mother I ask myself whether (in the correct dose) I would administer it to the child?
Nina
Thanks Nina,
But again I would doubt anything like that was published - maybe it was inference. There is not even a remote "link" to phenol and SIDS (that I can find or am aware of in evidenced based literature).
Phenol is not "absorbed" from localized use. There is no evidence to suggest application of phenol topically to any part of the body shows systemic absorption. There is no systemic uptake from application.
Lignocaine would have to be one of the most safe, benign drugs in the world!
Use of Xylocaine when breast feeding?
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