Which local anesthetic is SAFEST to use in pregnancy?

Correct answer: A. Lidocaine with epinephrine

• A. Correct. LIDOCAINE WITH EPINEPHRINE is the safest and most recommended local anesthetic during pregnancy. Lidocaine is FDA Category B, extensively studied, rapidly metabolized, and when used at appropriate dental doses with low-concentration epinephrine (1:100,000), poses minimal risk. The epinephrine prolongs anesthesia and reduces systemic absorption of lidocaine.
• B. Incorrect. Bupivacaine (Category C) is associated with potential fetal bradycardia and reduced uterine blood flow — less preferred in pregnancy.
• C. Incorrect. Mepivacaine crosses the placenta more readily and has a longer half-life in the fetus — generally AVOIDED in pregnancy.
• D. Incorrect. Articaine has high plasma protein binding but its safety in pregnancy is less well-documented than lidocaine.