1

Safety of Local Anesthetics in Pregnancy

Karen Morris

Dental Hygiene, South College

RDH #1430: Pain Management

Ms. Sarah McKinney

February 17, 2023

 2

Safety of Local Anesthetics in Pregnancy

During pregnancy, many changes occur in the woman's body. The changes

that occur during pregnancy can alter the body's response to different local

anesthetics delivered when receiving dental treatment. It is crucial that this is taken

into consideration when administering local anesthetics to expecting patients. The

safety of local anesthetic delivery during pregnancy is detrimental to providing

safe and effective treatment to a patient. It is critical that the clinician understands

how secure it is to administer local anesthetics to pregnant patients to ensure no

harm to the patient and the fetus.

Lee and Shin (2017) discuss the effects of local anesthetics on pregnant

women and their level of safety. This article addressed the many changes that take

place in the body of the pregnant patient, such as changes in liver function, renal

system, endocrine function, and metabolism that can be contraindications for local

anesthetics. In response, studies discussed in this article aimed to determine the

toxic effects of local anesthetics. Toxicity effect studies were conducted by the

administration to fetal and not fetal lambs. The gravity of the effects of local

anesthetics on the fetus was determined by the amount of local anesthetic delivered

across the placenta. However, according to this article, studies determined that

local anesthetics did not increase the prevalence of adverse pregnancy outcomes.
 3

Yenen and Atacag (2019) addressed the importance of sustaining oral health

during pregnancy. Upholding oral health included receiving the necessary

treatment needed, including the administration of local anesthetics. According to

this article, publications indicate dental treatments such as local anesthetics can be

completed safely during pregnancy. The safe periods throughout pregnancy are

stated to be in the second trimester. Thus, the need to avoid the first and second

trimesters due to the sensitivity of the changes that occur in these trimesters.

However, completing treatment in these trimesters was deemed appropriate in the

instance of pain and if no potential harm could come from the treatment.

Saliba, T, Custodio, Saliba, N, and Moimaz (2019) concentrated on oral

health care methods for pregnant women. Methods included the management of

dental procedures for pregnant women. The use of local anesthetics in pregnancy

was said to be controversial. However, studies deemed local anesthetics safe in

pregnancy when there are no systemic contraindications. In the presence of

systemic contraindications, the recommended primary anesthetic option was 2%

lidocaine with adrenaline 1:100,000 or noradrenaline 1:50,000. Second to

lidocaine, mepivacaine when longer procedures are needed. Although deemed safe,

restrictions in anesthetics were also discussed. Limitations included felipressin as a

vasoconstrictor due to the chance of uterine contraction.

 4

The articles discussed all focused on the safety of local anesthetics in

pregnancy. Lee and Shin (2017) deemed local anesthetics safe in pregnancy,

focusing on the amount of anesthetic that travels through the placenta. Yenen and

Shin (2019) also thought the use of local anesthetics is safe in pregnancy when

treating in appropriate stages of pregnancy. Saliba, T, Custodio, Saliba, N, and

Moimaz (2019) similarly held local anesthetics safe in pregnancy in the absence of

systemic contraindications and when suitable selections of local anesthetic in the

presence of contraindications are made. The criteria deeming the safety of local

anesthetics in pregnancy differed in each discussed article. However, all articles

deemed the use of local anesthetics safe in pregnancy.

Although the rationale for local anesthetics safety in pregnancy differed in

each article, it is clear that maintaining knowledge of the level of safety was

deemed essential. Clinicians must always be aware of the risks patients may be

exposed to and treat them as safely and appropriately as possible. Taking into

consideration all criteria that make treating a pregnant patient safe or unsafe into

consideration is critical in the use of local anesthetics.

 5

References

Lee, M. J., Shin, J. T. (2017). Use of local anesthetics for dental treatment during

pregnancy; safety of parturient. Journal of Dental Anesthesia and Pain

Medicine, 17(2), 81-90. https://synapse.koreamed.org/articles/1060566

Saliba, A. T., Custodio, B. L., Saliba, A. N., Moimaz, A. S. (2019). Dental prenatal

care in pregnancy. Revista Gaucha de Odontologia. 1-8.

https://www.scielo.br/j/rgo/a/9wcwfhGdZq8y8xj5ZCQVQbF/?format=pdf&l

ang=en

Yenen, Z., Atacag, T. (2019). Oral care in pregnancy. Journal of the Turkish-

German Gynecological Association, 20(4), 264-268.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883753/