Re:  Lidocaine and epinephrine


Lidocaine is no problem for a breastfed infant.  First the amount used in
local injections is minimal, and secondly, its bioavailability is poor due
to first pass uptake in the liver.

Secondly,  epinephrine is added to local tissue injections of local
anesthetics, because it induces a strong vasoconstriction in the tissue and
thus reduces the loss of lidocaine,  hence lidocaine stays in the region
longer and produces a longer analgesia.

Epinephrine is rapidly fixed in tissues, and any that dissipates to the
plasma compartment is sequestered in the liver and almost instantly
destroyed by MAO and other enzymes.  Were it to enter the milk, and
subsequently the GI tract of the infant (which is unlikely), it would be
destroyed by gastric acidity, with virtually no bioavailability.


Regards

Tom Hale, R.Ph., Ph.D.
Associate Professor of Pediatrics

http://neonatal.ttuhsc.edu/lact/