Local and Epidural Anesthesia / Neuraxial analgesia

Topical anesthetics, for local, dental, root or epidural use, have no clinically significant systemic absorption. ^{(Reece 2017).}

NEURAXIAL ANALGESIA (EPIDURAL, SPINAL): Used to reduce pain in areas below the waist, such as during childbirth. The injected local anesthetic has no effect on breastfeeding or the infant. It usually associates with an opioid derivative, usually fentanyl. 

Unlike general anesthesia, epidural anesthesia allows skin-to-skin bonding of the mother with the baby immediately after delivery and breastfeeding ^{(Roshan 2022, p111)}. Regarding the epidural, general anesthesia was associated less frequently with breastfeeding and exclusive breastfeeding at 6 weeks ^{(Orbach 2018)} and at 6 months ^{(Karasu 2018)}. The use of local anesthetics and regional anesthesia (spinal, epidural or peripheral block) decreases the need for opioids and other analgesics which can interfere with breastfeeding ^{(Reece 2017)}

The use of epidural anesthesia has seen increased instrumented delivery and cesarean sections related to fetal distress, misleading overweight of the child at birth (via fluids administered to the mother) and breast engorgement.

There is controversy ^{(Szabo 2013, Reynolds 2011, Camann 2007, Halpern 2005)} over whether drug analgesia during childbirth (epidural with local anesthetics with the addition or not of fentanyl) can or can't affect the onset and duration of breastfeeding, whether due to delayed lactogenesis II, or due to impairment of the infant's own competencies. ^{(Roshan 2022 p419, Oommen 2021, Takahashi 2021, Heesen 2021, French 2016, Herrera 2015, Howie 2006)}

• There are studies that show that with epidural anesthesia there is a greater risk of delaying the lactogenesis II period (stimulation of milk production) beyond 3 days ^{(Herrera 2015, Lind 2014)}, lower self-efficacy ^{(Nilsson 2020)} and lower frequency and duration of breastfeeding ^{(Oommen 2021, Agea 2020, Torvaldsen 2006)}, although they do not affect the initial weight loss of the newborn. In some studies, the newborn appears to be at greater risk of delaying the first breastfeeding, due to having a higher body temperature and presenting irritability or drowsiness ^{(Ransjö 2001)}. Epidural anesthesia can reduce prolactin levels ^{(Uvnäs 2020)}. This being the case, more support will be needed for breastfeeding mothers who have received analgesia ante- and intra-partum. ^{(Zuppa 2014)}
• But other studies do not find significant problems in the initiation and maintenance of breastfeeding due to epidural anesthesia in childbirth or caesarean section. ^{(Fan 2020, Mahomed 2019, Xu 2019, Grant 2019, Lee 2017, Mauri 2015, Shrestha 2014, Zuppa 2014, Wilson 2010, Wieczorek 2010, Goma 2008, Chen 2008, Wang 2005, Chang 2005, Radzyminski 2003)}
• Some authors found a shorter duration of the first breastfeeding but no delay in the onset of breastfeeding or other problems related to breastfeeding ^{(Gizzo 2012)}. The onset of breastfeeding was earlier and with more frequent feeds in vaginal delivery than after caesarean section and with epidural anesthesia than with general anesthesia. ^{(Kutlucan 2014, Sener 2003)}

It appears to be of more paramount importance the women's support for the establishment and continuation of breastfeeding, than the negative effect that would be exerted by administration of analgesia or anesthesia during labor.
 ^{(Zuppa 2014, Torvaldsen 2006)}

Postoperative pain control with continous epidural bupivacaine continues for 3 days after caesarean section improved breastmilk production and infant weight gain ^{(Hirose 1996)}, but the opposite occurred when buprenorphine was associated ^{(Hirose 1997)}. There is consensus that there is greater milk production and greater neonate weight gain if pain is adequately controlled pharmacologically after delivery or cesarean section.

See below the information of these related products:

• (General Anesthesia) (Safe substance and/or breastfeeding is the best option.)
• Bupivacaine (Safe substance and/or breastfeeding is the best option.)
• Fentanyl (Safe substance and/or breastfeeding is the best option.)
• Lidocaine (Safe substance and/or breastfeeding is the best option.)
• Mepivacaine Hydrochloride (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Ropivacaine Hydrochloride (Safe substance and/or breastfeeding is the best option.)

See below the information of this related group:

• ATC N01A: Anesthetics, general