Which local anesthetic is considered safest for pregnant and lactating women?

Lidocaine is considered the safest local anesthetic for pregnant and lactating women due to its established safety profile. Extensive research and clinical experience have demonstrated that lidocaine has minimal systemic effects and is well-tolerated when used as directed. It also has a low placental transfer rate, making it a preferred choice for dental procedures in pregnant patients.

In addition, lidocaine’s low toxicity and the short duration of its effects contribute to its safety, allowing it to be used with more confidence in these populations. Furthermore, it is considered a category B drug by the FDA, indicating that it has not shown any evidence of risk to the fetus based on studies conducted on animals, and there haven't been adequate and well-controlled studies in humans.

While the other local anesthetics listed can also be used in certain situations, they carry different levels of risk or fewer studies supporting their use in pregnant and lactating women compared to lidocaine. For instance, bupivacaine has a longer duration but also a higher risk of systemic toxicity, while articaine and mepivacaine do not have as extensive a safety profile documented specifically in pregnant populations. Thus, lidocaine remains the most appropriate and recommended choice for these groups.