Ropivacaine use while Breastfeeding
Drugs containing Ropivacaine: Naropin, Naropin SDV, Naropin Novaplus, Naropin Polyamp
Ropivacaine Levels and Effects while Breastfeeding
Summary of Use during Lactation
Ropivacaine passes into milk poorly and is not orally absorbed by breastfed infants. Infants appear not to be affected by the small amounts of drug in breastmilk.
Local anesthetics administered during labor and delivery with other anesthetics and analgesics have been reported by some to interfere with breastfeeding. However, this assessment is controversial and complex because of the many different combinations of drugs, dosages and patient populations studied as well as the variety of techniques used. Published data on the use of ropivacaine and fentanyl used during labor and delivery in a small number of women found no adverse effects on breastfeeding.
Drug Levels
Maternal Levels. Twenty-five women undergoing cesarean section received ropivacaine 0.15% and fentanyl 2 mcg/mL for patient-controlled epidural analgesia at a basal rate of 6 mL (9 mg of ropivacaine)/hour and a demand dose of 4 mL (6 mg ropivacaine)/20 minutes. The cumulative maternal dosages of ropivacaine at 18 and 24 hours averaged 188 mg (range 69 to 296 mg), and 248 mg (131 to 378 mg), respectively. At 18 and 24 hours postpartum, colostrum ropivacaine concentrations averaged 246 mcg/L and 301 mcg/L, respectively.[1] Using these results, a neonate who ingests about 40 mL of colostrum during the first 24 hours of life would receive only 10 to 12 mcg of ropivacaine.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Twenty-five infants whose mothers received a combination of ropivacaine and fentanyl for patient-controlled epidural analgesia for pain associated with cesarean section had normal Apgar and Neurological and Adaptive Capacity scores. No adverse effects were noted in any of the infants.[1]
Possible Effects on Lactation
A prospective cohort study compared women who received no analgesia (n = 63) to women who received continuous epidural analgesia with fentanyl and either 0.08 or 0.2% ropivacaine (n = 13) or bupivacaine (n = 39) during labor and delivery. The total dosage of ropivacaine was 50 to 124 mg and the average total infusion time from start to delivery was 219 minutes. The study found no differences between the groups in breastfeeding effectiveness or infant neurobehavioral status at 8 to 12 hours postpartum or the number exclusively or partially breastfeeding at 4 weeks postpartum.[2]
A randomized, prospective study compared mothers who received epidural labor analgesia with ropivacaine (n = 75) to mothers who did not receive labor analgesia (n = 49). In the treatment group, 3 mL of ropivacaine 0.125% was injected epidurally, followed in some mothers by an additional 12 mL. In all treated mothers, 5 mL per hour was then given as a continuous epidural infusion. Although serum prolactin concentrations were somewhat lower in the group who received ropivacaine, no difference was seen between the groups in time of lactation onset, number of women with extensive lactation, and the decrease in infant weight reduction.[3]
Alternate Drugs to Consider
References
1. Matsota PK, Markantonis SL, Fousteri MZ et al. Excretion of ropivacaine in breast milk during patient-controlled epidural analgesia after cesarean delivery. Reg Anesth Pain Med. 2009;34:126-9. PMID: 19282712
2. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005;21:305-14. PMID: 16113019
3. 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;43:502-5. PMID: 19080512
Ropivacaine Identification
Substance Name
CAS Registry Number
84057-95-4
Drug Class
- Anesthetics, Local
Administrative Information
LactMed Record Number
617
Information from the National Library of Medicine's LactMed Database.
Last Revision Date
2011-01-04
Disclaimer
Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
See Also...
- Ropivacaine use during Pregnancy
- Ropivacaine Consumer Information
- Breastfeeding Support Group
- Safe Medications during Breastfeeding
- Medicine use while Breastfeeding
- Medicine use during Pregnancy
Disclaimer: This information is not intended as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. Use of this website signifies your agreement to the Terms of Use and Online Privacy Policy.
