Medication Summary
The goals of pharmacotherapy are to suppress ovulation and to prevent pregnancy.
Progestins
Class Summary
Agents in this class prevent pregnancies.
Etonogestrel (Implanon, Nexplanon)
Etonogestrel is the active metabolite of desogestrel that suppresses ovulation, inhibits endometrial proliferation, and increases viscosity of cervical mucus.
Local Anesthetics, Amides
Class Summary
Local anesthetics block the initiation and conduction of nerve impulses.
Lidocaine (Xylocaine)
Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. After cleaning the insertion site with antiseptic, sterile gloves should be worn by the practitioner. In preparation for local anesthesia, 1-2 mL of 1% lidocaine with or without epinephrine should be drawn into a syringe with an 18-gauge needle. Then, a smaller 25-gauge needle should be applied to the syringe. The lidocaine should be injected along the planned subdermal insertion site of the implant to both hydrodistend and anesthetize the space where the implant is to be inserted.
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Patient's wrist is parallel to her ear or her hand is positioned next to her head.
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The insertion site, which is at the inner side of the nondominant upper arm about 8cm above the medial epicondyle of the humerus.
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The transparent protection cap should be removed by sliding it horizontally away from the device.
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With your free hand, use countertraction on the skin as you insert the needle at a 30 degree angle.
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Once the needle has punctured the skin, hold the applicator horizontal to the skin, and tent the skin upwards as you slide the entirety of the needle into the subdermal space.
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While holding the applicator in place, unlock the purple slider with your index finger by pushing the slider downwards and backwards until it locks.
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At this point the needle is inside the applicator and the applicator can be removed from the field.
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The practitioner and patient should palpate the implant immediately after insertion.
