Umbilical Hernia Surgery and Exparel

[NursingMom815]

I'm trying to determine when it is safe to breastfeed after undergoing surgery at 1:30pm yesterday. I received Exparel to help with pain. I've received conflicting information ranging from 8-24 hours. Of course, googling information made me even more paranoid. Can you tell me when it's safe after a procedure such as this? Thank you so much for your help.

[admin-james]

Hi, thanks for your post.

We actually looked into this problem a while ago, but I totally forgot to post it on the website. Thanks for the reminder. The short answer is that typical doses of Exparel are totally compatible with breastfeeding without restriction. Here's the long answer we wrote in response to a specific question about Exparel in C-sections:

The available pharmacokinetic data on Exparel suggest that 266mg produces an immediate peak (due to a small amount of extraliposomal bupivacaine in the formulation) which drops off at 2hrs to a plateau of around 360 ng/mL. Half-life of elimination varies by route of administration between 12 and 34 hours. During early postpartum, the lactocyte barrier is not fully formed and the milklasma ratio of most drugs is near 1:1. New mothers also only produce an average of 60 mL of colostrum per day. We believe that circulating bupivacaine derived from Exparel is not pharmacologically different than regular bupivacaine. Assuming a sustained plasma level of 360 ng/mL in both milk and plasma, that would be 21 mcg / day of bupivacaine delivered to the infant. The oral bioavailability of bupivacaine is not known, but using lidocaine as a model (~30%), that is 7 mcg per day in the infant's plasma.

The volume of distribution for bupivacaine is high (0.4-1.0 L/kg), implying that plasma levels in the baby will be very low with this level of exposure. In adults, toxic effects are first seen at around 2000 ng/mL. It is our opinion that plasma levels in the baby are highly unlikely to come anywhere close to this. In summary, we believe that use of Exparel at these dosages is compatible with breastfeeding without restriction.

James Abbey, MD and Thomas W. Hale, Ph.D.
InfantRisk Center

Hu D, Onel E, Singla N, Kramer WG, Hadzic A. Pharmacokinetic profile of liposome bupivacaine injection following a single administration at the surgical site. Clin Drug Investig. 2013 Feb;33(2):109-15. PMID: 23229686.

[rintaloves]

Glad that you posted this info.

I just had an umbilical hernia surgery 2 days back and was feverishly browsing online if it was OK to breastfeed now. The surgery went fine, and the folks over at the Shouldice hospital in Ontario (shouldice.com) told me that it was OK to breastfeed, but I guess I just needed a second opinion. Thanks again!

[Sandra]

NursingMom815, thanks for posting,

With general anesthesia where they usually use propofol, fentanyl, versed, a anesthetic gas such as sevoflurane, a steroid and sometimes an antibiotic we would recommend waiting a minimum of 4 hours provided you are completely awake at that time, and your infant is not premature, and/or the infant does not have a history of apnea. I hope this helps.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519