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In the arms of morpheus: the development of morphine for postoperative pain relief

Abstract

Purpose: To analyse the historical development of morphine for postoperative analgesia and how this development was shaped by the evolution of anesthetic techniques.

Methods: After a systematic review of the literature, information was gathered from primary sources.

Principal Findings: In ancient medicine, some plant derivatives were used to alleviate pain including: alcohol, cannabis, mandrake, and opium. Over the past two centuries, opium and its derivatives have become the most widely used analgesics for severe pain. Before the development of general anesthesia, surgery was only performed out of extreme necessity. It is probable that an analgesic such as opium would have been given following surgery although its use may not have been recorded. The first description of postoperative opium was by James Moore in 1785. Morphine was isolated from opium by Friedrich Serturner in 1805. However, it was not until the development of the hypodermic needle and syringe nearly 50 yr later that the use of morphine became widespread. Over the last century, various delivery systems for morphine have been developed including subarachanoid and epidural injection, and more recently patient-controlled intravenous, epidural and intranasal analgesia. In addition, many new opioids have been synthesized.

Conclusion: Since its isolation from opium almost 200 yr ago, morphine remains the most widely used analgesic and the standard against which all new opioids for postoperative pain relief are compared.

Résumé

Objectif: Décrire le développement historique de la morphine comme analgésique postopératoire et montrer comment il a été façonné par l’évolution des techniques anesthésiques.

Méthode: On a d’abord passé systématiquement en revue la documentation pertinente, puis rassemblé les informations des principales sources.

Constations principales: La médecine ancienne utilisait certains dérivés de plantes pour soulager la douleur: l’alcool, le cannabis, la mandragore et l’opium. Au cours de deux derniers siècles, l’opium et ses dérivés sont devenus les analgésiques les plus utilisés contre la douleur vive. Avant l’avènement de l’anesthésie générale, l’intervention chirurgicale n’était réalisée qu’en cas d’extrême nécessité. Il est probable qu’un analgésique comme l’opium ait été administré à la suite d’une opération sans qu’on en consigne l’emploi. La première description de l’utilisation postopératoire d’opium revient à James Moore en 1784. La morphine a été isolée de l’opium par Friedrich Serturner en 1805. Cependant, son usage ne s’est répandu qu’avec l’arrivée, 50 ans plus tard, de l’aiguille hypodermique et de la seringue. Pendant le siècle dernier, on a mis au point différents systèmes d’administration de la morphine, y compris l’injection sous-arachnoïdienne et péridurale et, plus récemment, l’analgésie intraveineuse, péridurale et intranasale contrôlée par le patient. De plus, nombre de nouveaux opioïdes ont été synthétisés.

Conclusion: Depuis que la morphine a été isolée de l’opium, il y a près de 200 ans, elle demeure l’analgésique le plus utilisé et une norme de comparaison pour tout nouvel opioïde utilisé pour soulager la douleur postopératoire.

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Correspondence to Thomas F. BAskett MB FRCSC.

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Hamilton, G.R., BAskett, T.F. In the arms of morpheus: the development of morphine for postoperative pain relief. Can J Anesth 47, 367–374 (2000). https://doi.org/10.1007/BF03020955

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Keywords

  • Morphine
  • Opium
  • Opioid Receptor
  • Postoperative Analgesia
  • Saffron