Ropivacaine

Drug Levels and Effects:




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 little or no adverse effect 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) orbupivacaine(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]

A study at one Italian hospital compared primaparous mothers undergoing vaginal delivery who received epidural analgesia (n = 64) to a random sample of those who did not (n = 64). Mothers who requested the epidural analgesia received an initial dose of 100 mcg of fentanyl diluted to 10 mL with saline. After the initial fentanyl, doses of 15 to 20 mL of 0.1% ropivacaine were administered, if needed; however, the number of women who received ropivacaine was not reported. The only difference between the groups of mothers was a longer duration of labor among the treated mothers. The quality of infant nursing was equal between the 2 groups of infants on several measures; however, more infants in the treated group breastfed for less than 30 minutes at the first feeding.[4]


Alternate Drugs to Consider:


Bupivacaine,Lidocaine


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
4. Gizzo S, Di Gangi S, Saccardi C et al. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med. 2012;7:262-8. PMID:22166068



Substance Identification:




Substance Name:

Ropivacaine

CAS Registry Number:

84057-95-4

Drug Class:


  • Anesthetics, Local


  • Administrative Information:




    LactMed Record Number:


    617


    Last Revision Date:


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