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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

At the Harbor-UCLA Medical Center in Torrance, California, 46 consecutive women, 17-34 years old, seeking the contraceptive implant Norplant were randomly assigned to either the group that first received three infiltrations of lidocaine buffered with 7.4% sodium bicarbonate (pH 6) followed by 2% unbuffered lidocaine (pH 7.27) or the group that received these medications in reverse order. Researchers aimed to determine whether the addition of sodium bicarbonate to the lidocaine solution would affect the discomfort/pain when providers inserted the Norplant System. 36 of the women were Hispanic. Vaginal childbirth was the worst pain most women (32) had experienced in the past. 30 of the 46 women experienced less pain with the buffered solution than with the unbuffered solution. On the pain scale of 1 (no pain) to 10 (worst pain in their lives), the pain score fell by 1.17 points (29%) with the buffered solution (p = 0.0098). These results suggest that, if providers used buffered lidocaine, women who were apprehensive about insertion pain might be more likely to accept the Norplant system for contraception.
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PMID:Neutralizing pH of lidocaine reduces pain during Norplant system insertion procedure. 762 4

Research on contraceptive implants began when it was learned that steroids could be released from Silastic rubber capsules. The six-capsule Silastic drug delivery system, which would eventually be called Norplant, was by 1974 perfected and prepared for clinical trials. By 1978, data had accumulated to indicate a failure rate for Norplant after two years of only 0.6%, so Leiras Pharmaceuticals of Turku, Finland, was licensed in 1983 to manufacture Norplant, and Finland became the first country to give regulatory approval for distribution of the new contraceptive. The World Health Organization, after a 1984 evaluation, concluded that the Norplant system is an effective, reversible, long-term method of fertility regulation which is particularly appropriate for women in need of long-term contraceptive protection. Wyeth-Ayerst Laboratories began to distribute the device in the US after it met US Food and Drug Administration approval. 24 countries have now approved Norplant for distribution and use among women. This paper describes the Norplant contraceptive system, its mechanism of action, insertion and removal, effectiveness, contraindications, and adverse effects with regard to menstrual problems, medical problems, infection or pain, drug interactions, ectopic pregnancy, foreign body carcinogenesis, and other adverse reactions. It also notes use benefits in terms of contraceptive action, convenience, the reduction of adverse reactions for former oral contraception users, and the prevention of anemia, and lists categories of potential acceptors and women who may not wish to use Norplant.
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PMID:Implantable contraception. 770 29

Approximately 3000 Norplant insertions have been performed to date at the Grady Health System in Atlanta, Georgia (US). In a 12-month study of a subset of women who terminated this method, 10.1% cited pain at the site of insertion as the major reason for contraception discontinuation. Given the proximity of major nerves and veins to the implant site, some of this pain may result from neurovascular injury associated with Norplant insertion. In fact, a disproportionate number of women with arm pain had the implants inserted immediately over the brachial groove. The Wyeth-Ayerst manufacturer's brochure suggests only that the implants be inserted on the inner aspect of the upper arm 8-10 cm above the elbow crease. Insertion of the implants deeply over the brachial groove introduces potential for trauma to the ulnar and median nerves, the basilic vein, and the brachial artery. This risk is increased when the trocar is advanced forcibly during insertion of the implants and when the tissue around the implants is dissected during the removal of deeply placed implants in the brachial groove. Recommended, to reduce the risk of significant injury, is insertion of the implants over the medial surface of the biceps brachii.
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PMID:Neurovascular injury during removal of levonorgestrel implants. 784 17

A resident at the Family Practice Clinic of the University of California, Davis, inserted a levonorgestrel implant (Norplant system) into a 25-year-old African-American women as she requested. The resident used the 7-step method recommended by the manufacturer to insert the implant. The woman went to the emergency department 24 hours after the insertion because the insertion site had diffuse redness, swelling, and blistering. Physicians prescribed 500 mg dicloxacillin every 6 hours for 10 days to treat suspected cellulitis. She returned to the clinic 1 week later, at which time the redness and blisters had disappeared. No drainage, fluctuance, or tenderness remained at the insertion site, which was clean. At her 3 month follow-up appointment, the insertion site itched constantly. The physician noted a fan-shaped area of hyperpigmentation at the insertion site. The physician prescribed 0.1% triamcinolone cream and told her to return for follow-up care. She returned in 3 months with complaints of itching and pain at the site. The physician noticed a fan-shaped keloid over the implant site and at the wound site. The patient asked for the implants to be removed. The physician did not encounter any difficulties in removing the 6 capsules and injected aqueous triamcinolone acetate into the keloid. Her mother had also experienced keloid formation. Resolution of the keloid at the implant site was noted at her 6-month follow-up visit. Based on a review of the literature, the cause of blister formation and subsequent keloid formation was likely multifactorial. The risk for keloid formation is highest in people with deeper skin pigmentation regardless of race, a family history of keloid, own history of keloid, and ethnic background. Patients should be counseled about the possibility of skin reactions such as keloid to implants.
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PMID:Keloid formation from levonorgestrel implant (Norplant System) insertion. 785 93

Between August 1991 and April 1993, in Texas, family planning specialists analyzed prospective data on 2358 women who underwent Norplant system insertions at either the Division of Maternal Health and Family Planning clinics of the University of Texas Southwestern Medical Center or at Parkland Memorial Hospital. The household income of about 90% of the women was at or below the poverty level. Health workers counseled each woman expressing interest in Norplant individually so the women understood the risks, benefits, and side effects. The women had access to health workers via telephone, clinic appointment, or clinic walk-in visits when they had questions and concerns. At the time of insertion, 43% of the women were no older than 19 years of age. 14% were 16-years-old or younger. 63% of the 431 women who received Norplant immediately after delivery were no more than 19-years-old. 74% of all the women had at least one concern about Norplant. The leading concern was pain at the time of insertion (32.1%) followed by weight changes (14.8%), and menstrual changes (12.2%). As of August 1993, only 138 (5.85%) of the women requested removal (adolescents = 40%). The reasons for removal included irregular bleeding (41.3%), headache (22.5%), pain in the arm with Norplant (18.1%), weight gain (14.5%), hair loss (10.1%), mood changes (8%), and desire for pregnancy (8%). The researchers had not anticipated the high incidence rates of arm pain, hair loss, and mood changes. These findings suggested that Norplant is an acceptable longterm contraceptive method. Other studies showed that it is also very effective.
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PMID:A preliminary report of Norplant implant insertions in a large urban family planning program. 822 63

Between April and October 1991 in Baltimore, Maryland, family planning providers tried to follow 246 13-42 year old women at a clinic at the Francis Scott Key (FSK) Medical Center for 3 months who accepted the levonorgestrel-releasing implant Norplant to evaluate its acceptability and effectiveness among a high-risk population. 56% of the women were Black and 41% White. 69% were single. Most were interval gynecologic patients (109), but many were postabortion patients (97). The providers could only follow 108 women. Reasons for unscheduled visits were insertion site tenderness, amenorrhea, and removal. At 1 month, 70 % had at least 1 side effect. 48% had irregular bleeding 1-2 months after insertion. Other side effects included headache (49%), acne (24%), weight gain (22%), increased appetite (19%), and dizziness (18.5%). The 24-hour telephone hotline had only received 38 problem calls, all of which were from FSK Norplant patients. More than 50% of the calls were about menstruation concerns. Reasons for removal included pressure to receive Norplant, increased acne, headaches and prolonged bleeding, and postinsertion site problems. 1 woman became pregnant, but it occurred before insertion. She underwent an abortion and continued to use Norplant. 78% of the women considered Norplant to be excellent and 14% considered it to be good. 95% would recommend it to others. 69% reported convenience to be the best thing about Norplant and 22% said it was pregnancy prevention. Worst things were irregular bleeding (26%) and progestin-related side effects (e.g., headaches and weight gain) (19%). 35% did not consider anything to be bad about Norplant. 64% had at least some apprehension before insertion, the major reasons being fear of needles (48%) and of pain (37%). Prior to insertion, just 37% were worried about potential side effects. The providers thought that the routine follow-up visit at 1 month was not cost-effective and provided no specific clinical benefit. They advocated adequate counseling about side effects to take the place of the follow-up visit.
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PMID:Preliminary experience with Norplant in an inner city population. 844 19

Norplant was first introduced in Ethiopia in 1994. This study examines the safety, efficacy, tolerance, and acceptability of Norplant among 364 patients of reproductive age who obtained implants from the Family Planning Department of the Gandhi Memorial Hospital during June-December, 1994. During the study period, 608 patients were provided with information about family planning methods. 110 accepted injectables, and 115 accepted oral pills. 96.7% of patients were married, 84.3% were urbanites, 84.9% were educated, 70.1% were housewives, and 91.5% were Christians. The mean age was 27.9 years. Ages ranged from 17 to 45 years. The mean body weight was 53.5 kg. Blood pressure readings were low for most women. The mean number of living children was 3.1. 70.3% of Norplant patients switched from other family planning methods. The mean duration of contraceptive use was 23.5 months. The average duration of Norplant implants since insertion was 25.3 months. The range was 3-30 months. 33.0% women were lactating at the time of insertion. The mean time of insertion was 12.5 minutes. Times ranged from 5 to 20 minutes. Insertion was made in the medial aspect of the upper left arm for right-handed women. A 2 mm incision was made, and six flexible capsules were inserted in a fan-shaped pattern with the help of a trocar. Insertion was performed under aseptic conditions and local anesthesia. Patients were advised to keep the dressed site clean and dry for a week, at which time dressings were removed and the site was checked for infection. Other check-ups were made at monthly intervals for 3 months. The most frequent complications were irregular bleeding, amenorrhea, headache, weight change, and local pain at the insertion site. The continuation rate was 95.1%. 93.9% rated Norplant highly. Health personnel were the main source of information about Norplant.
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PMID:Norplant implants in Ethiopia. 929 31

Due to the placement of the Norplant contraceptive implant system with respect to the neurovascular bundle of the arm, ulnar nerve injury is a possible complication of implant removal. Presented in this article is a case of ulnar nerve injury with subsequent neuropathy related to removal of improperly placed implants. The patient, a 23-year-old US woman, requested Norplant removal after 3.5 years of complication-free use. Before removal, the implants were noted to lie directly over the most anterior aspect of the triceps muscle, with the lower end of the implants lying about 5 cm from the medial condyle of the elbow. The patient returned to the facility 4 days after uneventful Norplant removal with persistent pain, definite weakness of the ulnar innervated muscles of the right hand, and numbness over the hypothenar eminence and fourth and fifth digits. Clinical neurologic evaluation was consistent with an ulnar nerve injury with diminished motor and sensory amplitude. Repeat studies at 6 weeks demonstrated improved motor response. Potential insertion-related injuries can best be prevented by choosing the appropriate placement site on the medial surface of the arm and by exaggerated tenting of the skin to help assure superficial subdermal placement and avoid deep structures. Before removal, identification of the path of the ulnar nerve and the relationship of the implants to the brachial groove is recommended, especially in thinner women. If pain, paresthesia, or anesthesia persists 4-6 weeks after an injury, repeat nerve conduction studies should be ordered to help outline a rehabilitation plan.
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PMID:Ulnar nerve injury associated with removal of Norplant implants. 958 36

Since 1986, Thailand's National Family Planning Program has included the Norplant 6-capsule implant system. The present paper reports the results of a 3-year Phase III clinical trial of the newly developed 2-rod system (Norplant-2). A total of 140 women (mean age, 29 years), in Bangkok, were enrolled and 103 women completed 3 years of method use. The continuation rates at 1, 2, and 3 years were 93.9%, 89.2%, and 82.8%, respectively. There were no accidental pregnancies during the 3-year study period. The 3-year cumulative termination rate was 7.2% for personal reasons (e.g., divorce, husband underwent vasectomy), 4.6% for medical reasons (e.g., acne, headache, pain at the implant site), and 3.8% for menstrual irregularities. A total of 125 acceptors underwent Norplant removal either during or at the end of the study period. The incidence of difficult removals was 8%. In most of these cases, the difficulty involved rod breakage. The average time required for removal was 3.4 minutes. These findings indicate that Norplant-2 is a safe, effective, acceptable contraceptive method appropriate for inclusion in Thailand's family planning program. The potential for fragmentation of the rods during removal requires careful monitoring, however.
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PMID:Experience of Thai women in Bangkok with Norplant-2 implants. 986 3

When Norplant implants are inserted too deeply and cannot be palpated, or if they are located close to the neurovascular structures of the upper arm, radiologic guidance may be needed to locate and remove the implants without injury to surrounding structures. This paper describes a case in which digital subtraction fluoroscopic guidance was helpful in removing an implant located close to a major nerve near the axilla. This technique enables both localization and direct image-guided removal. The patient, a 36-year-old US woman, requested implant removal 18 months after insertion because she desired pregnancy. At removal of the sixth capsule, the patient reported pain suggestive of nerve stimulation. Soft tissue x-ray indicated the capsule was located deep in the tissues near the area of the brachial artery and nerve. Fluoroscopic-guided removal was successful in removing this capsule in 30 minutes.
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PMID:Removal of a Norplant implant located near a major nerve using interventional radiology-digital subtraction fluoroscopy. 1009 76


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