Topical Lidocaine-Prilocaine Cream Versus Lidocaine 1% Subcutaneous Infiltration During Nexplanon Insertion: A Randomized Controlled Study

Background: Subcutaneous injection of lidocaine 1% is a widely used anesthetic method in implant insertion. However, lidocaine injection may be painful due to the penetration of the skin by the needle. This may also cause bleeding or edema which may mislead the intact subdermal insertion of the implant .Lidocaine-prilocaine (LP) cream is an oil/water emulsion in which the oil phase is a eutectic mixture of two anesthetics: lidocaine 2.5% and prilocaine 2.5% in a ratio of 1:1 by weight.Objectives: Our objective is to compare the anesthetic effect of LP cream versus lidocaine subcutaneous infiltration during insertion of Nexplanon.Methods: The study was conducted on department of obstetrics and gynecology faculty of medicine Assiut and Luxor University. Eligible women requesting Nexplanon insertion for contraception were randomized to LP cream (n=130) vs. lidocaine 1% subcutaneous infiltration (n=130)Results: Statistical analysis of current results showed that visual analog scale (VAS) at nexplanon insertion was significantly higher however overall pain was significantly lower in cases “lidocaine- prilocaine cream” compared to control “lidocaine subcutaneous injection” group. Duration of application was significantly higher in cases compared to control group due to the time needed for the effect of used cream. Complications during insertion were significantly lower in cases compared to control group. Patient’s satisfaction was insignificantly different between both groups.Conclusion: Topical application of lidocaine-prilocaine cream before Nexplanon insertion significantly reduces the induced pain with subsequent easier insertions and less rate of procedure-related complications.