What is the current anaesthetic practice for implant insertions?

Adequate anaesthesia is an important procedural step when inserting contraceptive implants. Whilst the product information for Nexplanon^® describes a choice of anaesthetic spray or injection for insertion,1 the Faculty of Sexual & Reproductive Healthcare (FSRH) does not mention spray, solely recommending use of lidocaine injection.2 Therefore anaesthetic spray such as ethyl chloride, despite being a recognised technique for implant insertions, is not widely used.

What is ethyl chloride spray?

Ethyl chloride spray acts as a local anaesthetic when sprayed onto the skin. It is a fast acting vapo-coolant with minimal side effects and it can be safely used for sterile procedures with no additional risk of bacterial contamination.3 It is a long-established analgesic technique for insertion of cannulas and needles, particularly in paediatric care.

Why is an alternative anaesthesia needed?

Lidocaine injection provides effective anaesthesia, but may cause some discomfort during injection. It involves the cost, storage and management of needles, syringes, sharps disposal and local anaesthetic. Furthermore, the time taken to gather and prepare these items and then dismantle the trolley represents the greater part of the overall process.

The aim of this project was to evaluate whether use of ethyl chloride spray as an alternative anaesthetic for insertion of contraceptive implants is an innovation offering improvement for patients, increased productivity for the service …