Lidocaine with Epinephrine for Nexplanon Insertion
Lidocaine with epinephrine is recommended for Nexplanon insertion as it provides longer duration of anesthesia, decreased bleeding, and better visualization of the insertion site. 1
Rationale for Using Lidocaine with Epinephrine
The addition of epinephrine to lidocaine offers several advantages for Nexplanon insertion:
- Extended duration of anesthesia - Epinephrine prolongs the anesthetic effect of lidocaine, ensuring comfort throughout the procedure 1
- Reduced bleeding - Vasoconstriction from epinephrine decreases bleeding at the insertion site
- Better visualization - Less bleeding allows for improved visualization during the procedure, potentially reducing the risk of deep or improper insertion 2
Dosing Guidelines
- Maximum safe dose of lidocaine with epinephrine: 7 mg/kg 1, 3
- Maximum safe dose of lidocaine without epinephrine: 4.5 mg/kg 1, 3
- For most adult patients, 1-2 mL of 1% lidocaine with epinephrine (1:100,000) is sufficient for Nexplanon insertion
Safety Considerations
The historical concern about using epinephrine in terminal areas (fingers, toes, nose, ears, penis) has been refuted by extensive research. Multiple systematic reviews and randomized controlled trials have confirmed the safety of epinephrine in these areas 1.
Special Populations:
- Pregnancy: Lidocaine with epinephrine in small amounts appears safe for use in pregnant women, though elective procedures should be postponed until after delivery 1
- Cardiac patients: Lidocaine with epinephrine may be administered to patients with stable cardiac disease 1
Technique Tips
- Use buffered lidocaine (with sodium bicarbonate) to reduce pain during injection 1
- Inject slowly to minimize discomfort
- Allow sufficient time (2-3 minutes) for the anesthetic to take effect before Nexplanon insertion
- Ensure proper insertion technique to avoid complications such as nerve injury 2
Potential Complications
- Nerve injury: Proper understanding of regional anatomy and correct insertion technique is crucial to prevent nerve damage 2
- Deep insertion: Careful technique is essential to avoid deep implant placement that could complicate future removal 4
Alternative Approaches
For patients with needle phobia, a jet injector device (such as MadaJet XL®) may be considered as an alternative to traditional needle injection for administering lidocaine. Research has shown that patient pain perception with jet injector lidocaine delivery is statistically lower than with traditional needle delivery 5.
Remember that proper training on Nexplanon insertion and removal is mandatory for all healthcare providers before performing these procedures 6.