The patient for injection should be placed upon the back. When the
thigh is slightly flexed the wall of the abdomen is relaxed and should
the external ring be not dilated by the protrusion of a large hernia
the relaxation obtained by the flexing of the thigh and allowing the
flexed leg to rest against the other will relax and dilate the
external ring somewhat so that it may facilitate the free passage of
the needle and it will also permit of the more free moving of the
point of the needle in the loose cellular tissues as the needle is
gradually withdrawn.
Pelvis high and head low.
If the head is dropped low and the pelvis is high, a position easily
possible with some surgical chairs, the veins of the cord are depleted
and the likelihood of opening or entering a vein is diminished. This
posture should only be used where there is a well marked varicocele
and the suction method of inserting the needle should always be used.
When the veins are dilated the elevation and their depletion may
prevent the operator making several efforts to pass the needle without
striking them, a thing which is easily possible in the presence of a
canal full of dilated vessels.
Should there be a well marked varicocele the blunted needle should be
used so that it will not be possible to cut a vein by the moving of
the needle and at the same time the operator should move the point of
the needle slowly from side to side as it is withdrawn.
SKIN INFILTRATION TO PERMIT OF INSERTION OF LONG NEEDLE
WITHOUT UNDUE PAIN.
It may be well to infiltrate the skin slightly at the site of the
puncturing of the skin with the larger needle. To do this a weak
cocain or alypin solution should be used. This solution is made by the
addition of the cocain or alypin tablets to one or two drams of boiled
water.
A tablet containing six tenths of a grain of alypin or cocain is
sufficient for a dram solution. A few drops of this injected over the
external ring will permit of the passage of the needle through the
tough skin without pain. The pressing of the needle along the roof of
the canal is not usually sufficiently painful to call for much
complaint from the patient.
If the patients are nervous a preliminary injection of a one per cent
solution of cocain or alypin into the inguinal canal is not
contraindicated. To accomplish this the larger needle should be
screwed upon the infiltrating syringe and as the needle is pressed
into the canal the solution is slowly forced in front of the needle
point. If sufficient solution is thrown ahead of the needle the
passage of the needle along the inguinal canal is entirely painless.
The infiltration of skin or canal being complete the needle must be
withdrawn and the syringe emptied and the plunger pressed down so that
the empty syringe is attached to the needle through which the paraffin
injection is to be made when the operator has assured himself that the
needle has been passed as far as desired without traversing or
puncturing a vein.