What is the safest local anesthetic choice for a breastfeeding patient?

Correct answer: D. Lidocaine

• A. Tetracaine is primarily used topically; systemic use poses greater risks due to slower metabolism in some individuals.
• B. Mepivacaine is reasonable but has a longer half-life and greater lipid solubility than lidocaine, meaning slightly more potential transfer into breast milk.
• C. Articaine has adequate safety data, but lidocaine has longer-standing evidence for nursing mothers.
• D. Lidocaine (with or without epinephrine) is the preferred LA for breastfeeding patients. It has a short half-life, low oral bioavailability for the infant, and extensive safety data. Supported by ADA and lactation references as first-line.