毒理性
哺乳期使用总结:在连续静脉输注、硬脊膜外给药以及作为局部麻醉剂使用高剂量时,牛奶中利多卡因的浓度较低,婴儿对利多卡因的吸收不良。预期利多卡因不会对哺乳婴儿造成任何不良影响。无需特别注意事项。
在分娩和分娩期间使用利多卡因与其他麻醉剂和镇痛剂有人报告会干扰哺乳。然而,这一评估是有争议的和复杂的,因为研究了许多不同的药物组合、剂量和患者群体,以及使用了多种技术和许多研究设计的不足。总的来说,似乎在良好的哺乳支持下,硬脊膜外利多卡因,加或不加芬太尼或其衍生物,对哺乳成功几乎没有或没有不良影响。分娩疼痛药物可能会延迟哺乳的开始。
◉ 对哺乳婴儿的影响:在分娩期间,通过胸膜内或硬脊膜外途径给母亲服用60至500毫克剂量的利多卡因对他们的14名婴儿(无论是母乳喂养还是通过奶瓶接受母亲的母乳)没有影响。
一个神经病学小组报告说,在使用1%利多卡因对14名哺乳期偏头痛的母亲进行周围神经阻滞时,他们没有报告婴儿的副作用,并认为在哺乳期间进行该程序是安全的。
◉ 对哺乳和母乳的影响:一项随机研究比较了三组接受选择性剖宫产的女性,她们在切口部位接受了20毫升1%利多卡因加肾上腺素1:100:000的皮下输注。一组在切前给药,一组在切后给药,第三组在切前给药10毫升,切后给药10毫升。在切前和切后给药组的女性比切前给药组的女性更早开始哺乳(3.4小时对4.1小时)。在开始哺乳的时间上,切后给药组与其他组之间没有差异。
一项全国性的调查比较了从晚期怀孕到产后12个月的女性及其婴儿,比较了在分娩期间接受和不接受疼痛药物的母亲哺乳II期的时间。药物类别包括脊髓或硬脊膜外单独使用,脊髓或硬脊膜外加用另一种药物,以及其他疼痛药物单独使用。接受任何类别药物的母亲比不接受分娩疼痛药物的母亲有大约两倍的风险出现哺乳II期延迟(>72小时)。
一项埃及研究比较了2%利多卡因(n=75)与2%利多卡因加肾上腺素1:200,000(n=70)作为剖宫产后伤口浸润。接受肾上腺素联合利多卡因的患者在手术后的89分钟开始哺乳,而仅接受利多卡因的患者在132分钟开始哺乳。差异具有统计学意义。
◉ Summary of Use during Lactation:Lidocaine concentrations in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and the lidocaine is poorly absorbed by the infant. Lidocaine is not expected to cause any adverse effects in breastfed infants. No special precautions are required.
Lidocaine during labor and delivery with other anesthetics and analgesics has 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 and deficient design of many of the studies. Overall it appears that with good breastfeeding support epidural lidocaine with or without fentanyl or one of its derivatives has little or no adverse effect on breastfeeding success. Labor pain medication may delay the onset of lactation.
◉ Effects in Breastfed Infants:Lidocaine in doses ranging from 60 to 500 mg administered to the mother by intrapleural or epidural routes during delivery had no effect on their 14 infants who were either breastfed or received their mother's breastmilk by bottle.
A neurology group reported using 1% lidocaine for peripheral nerve blocks in 14 nursing mothers with migraine. They reported no infant side effects and considered the procedure safe during breastfeeding.
◉ Effects on Lactation and Breastmilk:A randomized study compared three groups of women undergoing elective cesarean section who received subcutaneous infusion of 20 mL of lidocaine 1% plus epinephrine 1:100:000 at the incision site. One group received the lidocaine before incision, one group received the lidocaine after the incision, and the third received 10 mL before the incision and 10 mL after. Women in the pre-and post-incision administration group initiated breastfeeding earlier than those in the pre-incision administration (3.4 vs 4.1 hours). There was no difference between the post-incision administration group and the other groups in time to breastfeeding initiation.
A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.
An Egyptian study compared lidocaine 2% (n = 75) to lidocaine 2% plus epinephrine 1:200,000 (n = 70) as a wound infiltration following cesarean section. Patients who received epinephrine in combination with lidocaine began breastfeeding at 89 minutes following surgery compared to 132 minutes for those receiving lidocaine alone. The difference was statistically significant.
来源:Drugs and Lactation Database (LactMed)