Background: Levonorgestrel implant removal is a common office procedure. These procedures can be difficult and uncomfortable for the woman. Many removal techniques use only small amounts of lidocaine to diminish tissue distortion and to allow palpation of the implants. We report an alternative technique that can maximize the anesthesia during removal procedures.
Technique: Using the "ice saline" technique, lidocaine is infiltrated proximal to the implant tips, creating a field block of the superficial medial antebrachial cutaneous nerves and anesthetizing the operative site without injecting lidocaine around the implants.
Experience: We began using this technique 3 years ago and have used it for more than 50 removals. There have been no complications, and the block appears to reduce the pain reported.
Conclusion: The proximal intradermal field block is an alternative anesthetic technique for levonorgestrel implant removal.