Above and beyond whether it is safe for the baby to use 2% Lidocaine, which 
perhaps it might be since IV admin is an L2 per Hale, would be the issue of 
what using a topical anesthetic would do to the blood vessels perfusing the 
nipple. My understanding is that anesthetics are vasoconstrictors. Since 
women having nipple pain are so often dealing with vasospasms, it seems 
counter-intuitive to me to apply somethng that would constrict the blood 
vessels leading to the nipple. If nothing else, an evaluation of whether 
vasospasm is contributing to the pain should be performed before prescribing 
this medication and if the woman is having vasospasms increasing circulation
(via heat) rather than decreasing circulation would make her feel better. And I 
would also think that reducing blood flow to the nipples would lead to slower 
healing. 

I would also be very curious to know whether it works. Do the women 
experience less pain after the application of the Lidocaine and for how long?
If it is effective then that is something to take into account and I would love 
to hear more about it.

Kathy Lilleskov RN IBCLC

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