Within twelve hours after the operation the tissues are almost certain
to become quite sensitive to pressure. The reaction may be followed by
considerable pressure pain for a day or two. Should the patient not be
comfortable while at rest, that is sitting about or lying down; then
something should be given to relieve the pain. Codeine is the most
satisfactory agent for preventing the patient from feeling pain during
the most acute stage of the reaction. Codeine does not put the patient
to sleep as does morphine, nor does codeine constipate or make the
skin itch. Codeine is only about one-third or one-fourth as toxic as
morphine and consequently it may be given in a proportionately larger
dose. It may be given in tablet form or in solution by the mouth. The
best way to administer it is in doses of one-half grain every hour
while the patient is suffering actual pain. Tell the patient that it
will relieve him of unpleasant symptoms during the reaction and that
it is undesirable that he should suffer from the reaction. In this way
the patient will be kept quite comfortable during the time that the
reaction is sufficient to cause pain. It is impossible to tell whether
the reaction will be such as to cause any pain or not. In case it does
not develop no internal treatment is necessary. Other agents may be
used to relieve pain, though none offer the advantages of codeine
without disadvantages. It is not advisable to let these patients
suffer from a severe reaction. It is better to meet the first
indications of pain with the free administration of codeine. The
patient should not know the nature of the drug, and as it produces
none of the peculiar effects of morphine it is not really a drug at
all dangerous from the habit forming standpoint.
Local applications of heat or cold may be used if the reaction is well
marked.
THE PRECAUTION USED TO PREVENT THROWING OF PARAFFIN
INTO THE CIRCULATION.
In all cases precautions should be taken to avoid throwing of the
paraffin mixture directly into the circulation. This is accomplished
by passing the needle slowly into the tissues which are to be injected
and while the needle is passing through the tissues it should have a
strong vacuum suction upon it so that should it strike a vein the
blood will immediately begin to flow into the needle. To illustrate
how easily blood may be sucked from a vein a hypodermic with a glass
barrel may be taken armed with a small needle. If the arm of a patient
be allowed to hang down the veins will distend and the point of the
needle may be slipped through the skin and into the vein. If the vein
is punctured by the needle point the instant the piston of the syringe
is drawn back a vacuum forms in the syringe and the blood will flow
into the syringe. This same method is to be used in the passage of the
larger paraffin needle or any paraffin needle only as the needle is
passed along its course the suction should be constantly exerted. This
constant suction is secured by simply attaching the half glass syringe
to the needle and then as soon as the point of the needle is under the
skin the piston is withdrawn and a vacuum formed. Then holding the
piston of the syringe out, maintaining the vacuum, the needle is
pushed slowly in as far as the operator desires to inject. Should
blood begin to flow into the needle at any point the onward passage of
the needle is stopped and is withdrawn and re-inserted in a somewhat
different direction, particularly if during the withdrawal a point is
found where the blood flows steadily into the syringe.
If at no point blood flows into the syringe it is plain that no vessel
of dangerous size has been punctured by the needle. The veins of the
cord are found rather closely around the cord and the cord usually
lies below and behind the sac so that should the operator aim to carry
his needle point along rather high in the canal he will be least
likely to encounter these vessels. It is not to be forgotten that the
veins of the cord are particularly likely to be somewhat dilated in
these cases of hernia and the operator is taking more or less of a
hazard in neglecting the suction technic outlined. It is not safe to
trust to the fact that the paraffin is injected in a solid state as is
asserted by some operators. It is true that paraffin in a liquid state
is more likely to flow into an opened vein than the paraffin in the
solid state, yet it is possible to throw a very small amount of solid
paraffin into a vein if no precaution is taken to prevent it, and
while a very small mass thrown directly into a vein would be harmless
in nearly all instances it might do considerable damage should it be
so unfortunate as to lodge in certain vessels.