Contraceptive implant removal: Case report and the role of an ultrasound-trained anesthesiologist in perioperative localization and regional anesthesia

Contraceptive implants offer a long-term reversible option for contraception. While palpable implants can be removed under local anesthesia in an office setting, nonpalpable implants can present greater safety challenges and may increase the overall complication rate of removal. We present the case of a 28 year-old female who presented for an elective upper extremity contraceptive implant removal. The implant could not be palpated, and imaging confirmed subfascial placement of the implant in muscle. Preoperatively, her implant was identified on ultrasound within the biceps brachii muscle and mapped to guide the dissection. An ultrasound-guided nerve block of the intercostobrachial and medial brachial cutaneous nerves was performed with subfascial deposition of local anesthetic. The implant was then successfully removed without any additional local anesthesia or analgesia. This case report highlights the role of anesthesiologist-directed localization and ultrasound-guided nerve blocks.