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.
Article PDF
Similar content being viewed by others
References
Tallmadge GK. Some anesthetics of antiquity. J Hist Med Allied Sci 1946; 1: 515–20.
Dwarakanath SC. Use of opium and cannabis in traditional systems of medicine in India. Bull Narc 1965; 17: 15–9.
Gunther RT. The Greek Herbal of Dioscorides, Book IV. London: Hafner Publishing Company, 1968: 473.
Kirkup J. Surgery before general anesthesia.In: Mann RD (Ed.). The History of the Management of Pain. Casterton Hall: Parthenon Publishing Group, 1988: 15–30.
Bergman NA. The Genesis of Surgical Anesthesia. Park Ridge: Wood Library-Museum of Anesthesiology, 1998: 18.
Sigerist He. Laudanum in the works of Paracelsus. Bull Hist Med 1941; 9: 530–44.
Macht DI. The history of opium and some of its preparations and alkaloids. JAMA 1915; 64: 477–81.
Moore J. A method of preventing or diminishing pain in several operations. London: J Cadell, 1784. Cited by Bergman NA. The Genesis of Surgical Anesthesia. Park Ridge: Wood Library-Museum of Anesthesiology, 1998: 349.
Bell B. A system of Surgery, 6th ed., Vol. 2. Edinburgh: Bell and Bradfute, 1796: 393–7.
McDowell E. Three cases of extirpation of diseased ovaria. Eclect Rep Analyt Rev (Philadelphia) 1817, 7: 242–4.
McDowell E. Observations on diseased ovaria. Eclect Rep Analyt Rev (Philadelphia) 1819; 9: 546–53.
Shoemaker JV. Materia Medica and Therapeutics, Vol 2. Philadelphia, 1891: 785.
Serturner FW. Trommsdorff’s Journal der Pharmazie fur Aerzte, Apotheker und Chemisten 1805; 13: 229–35.
Serturner FW. Trommsdorff’s Journal der Pharmazie fur Aerzte, Apotheker und Chemisten 1806; 14: 47–93.
Lockemann J. On Serturner. J Chem Educ 1951; 28: 277.
Serturner FW. Ueber das Morphium, eine neue salzfahige Grundlage, und die Mekonsaure, als Hauptbestandtheile des Opiums. Gilbert’s Annalen der Physik 1817; 55: 56–89.
Serturner FW. De la morphine et de l’acide meconique, consideres comme parties essentielles de l’opium. Annales de Chimie et de Physique 1817, 5: 21–42.
Gregory W. On a process of preparing economically the muriate of morphia. Edin Med Surg J 1831; 35: 331–8.
Wren C An account of the rise and attempts, of a way to conveigh liquors immediately into the mass of blood. Phil Trans 1665; 1: 128–30.
Lafargue GV. Note sur les effets de quelques medicaments introduits sous l’epiderme. Acad Sci Paris 1836; 2: 397–8, 434.
Lafargue GV. Lettre de M. le docteur Lafargue de Saint-Emillion, sur l’inoculation de la morphine avec la lancette. Bull Acad Med Paris 1836; 1: 13–18, 40–2.
Rynd F. Neuralgia- introduction of fluid to the nerve. Dublin Med Press 1845; 13: 167–8.
Rynd F. Description of an instrument for the subcutaneous introduction of fluids in affections of the nerves. Dublin Quarterly Journal Med Sci 1861; 32: 13.
Wood A. New method of treating neuralgia by the direct application of opiates to the painful points. Edin Med Surg J 1855; 82: 265–81.
Hunter C. On narcotic injections in neuralgia. Med Times Gazette 1858; 2: 408–9.
Hunter C. On narcotic injections in neuralgia. Med Times Gazette 1858; 2: 457–8.
Wood A. Treatment of neuralgic pains by narcotic injections. BMJ 1858; 1: 721–3, 755.
Hunter C. Practical remarks on the hypodermical treatment of disease. Lancet 1863; 2: 444–5, 675–6.
Howard-Jones N. A critical study of the origins and early development of hypodermic medication. J Hist Med 1947; 2: 201–49.
Stein C, Comisel K, Haimerl E, et al. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991; 325: 1123–6.
Stein C, Schäfer M, Hassan AHS. Peripheral opioid receptors. Ann Med 1995; 27: 219–21.
Paget J. Subcutaneous injection of morphia after operation, before restoration of consciousness after chloroform. Lancet 1863; 1: 48.
Corning JL. Spinal anaesthesia and local medication of the cord. NY Med J 1885; 42: 483–5.
Vandam LD. On the origins of intrathecal anesthesia. Reg Anesth Pain Med 1998; 23: 335–9.
Bier A. Experiments regarding the cocainization of the spinal cord. Reprinted in “Classical File” Surv Anesthesiol 1962; 6: 352–8. (originally from Dtsch Z Chir 1899; 51: 361–9.)
Matas R. Local and regional anesthesia with cocain and other analgesic drugs, including the subarchanoid method, as applied in general surgical practice. Philadelphia Med J 1900; 6: 820–43.
McGowan SW. Highlights of anaesthesia in Dundee.In: Barr M, Boulton TB, Wilkinson DJ (Eds.). Essays on the History of Anaesthesia. London: Royal Society of Medicine Press, 1996: 71–3.
Pert CB, Snyder SH. Opiate receptor: demonstration in nervous tissue. Science 1973; 179: 1011–4.
Kuhar MJ, Pert CB, Snyder SH. Regional distribution of opiate receptor binding in monkey and human brain. Nature 1973; 245: 447–50.
Snyder SH. Opiate receptors in the brain. N Engl J Med 1977; 296: 266–71.
Snyder SH. Opiate receptors and internal opiates. Sci Am 1977; 236: 44–56.
Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science 1976; 192: 1357–8.
Wang YK. Soulagement de la douleur par injection intrathécale de sérotonine ou de morphine. Annals Anesth Fr 1978; 19: 371–2.
Sicard JA. Les injections medicamenteuses extradurales par voie sacro-coccygienne. Compte Rend Soc de Biol 1901; 53: 396–8.
Cathelin F. Une nouvelle voie d’injection rachidienne. Méthode des injections epidurales par le procédé du canal sacré. Applications a l’homme. Compte Rend Soc de Biol 1901; 53: 452–3.
Behar M, Magora F, Olshwang D, Davidson JT. Epidural morphine in treatment of pain. Lancet 1979; 1: 527–30.
Bromage PR, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgeisa. Anesth Analg 1980; 59: 473–80.
Reiz S, Ahlin J, Ahrenfeldt B, Andersson M, Andersson S. Epidural morphine for postoperative pain relief. Acta Anaesthesiol Scand 1981; 25: 111–4.
Rawal N, Sjörstrand U, Dahlström B. Postoperative pain relief by epidural morphine. Anesth Analg 1981; 60: 726–31.
Henderson JM, Brodsky DA, Fisher DM, Brett CM, Hertzka RE. Pre-induction of anesthesia in pediatric patients with nasally administered sufentanil. Anesthesiol 1988; 68: 671–5.
Streisand JB, Hague B, van Vreeswijk H, et al. Oral transmucosal fentanyl premedication in children. Anesth Analg 1987; 66: S170.
Vincenti E. Sublingual opiates in acute pain. Adv Pain Res Ther 1990; 14: 227–31.
Gourlay GK, Kowalski SR, Plummer JL, Cherry DA, Gaukroger P, Cousins MJ. The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. Pain 1989; 37: 193–202.
Kalso E, Tramèr MR, Carroll D, McQuay HJ, Moore RA. Pain relief from intra-articular morphine after knee surgery: a qualitative systematic review. Pain 1997; 71: 127–34.
Raper HR. Man Against Pain. The Epic of Anesthesia. New York: Prentice-Hall, Inc., 1945; 212–3.
Scott JS. Obstetric analgesia. A consideration of labor pain and a patient-controlled technique for its relief with meperidine. Am J Obstet Gynecol 1970; 106: 959–78.
Sechzer PH. Objective measures of pain and pain relief following cardiovascular surgery. Rev Argent Angiol 1967; 1: 9–12.
Rawal N. Epidural and spinal agents for postoperative analgesia. Surg Clin North Am 1999; 79: 313–44.
Komatsu H, Matsumoto S, Mitsuhata H, Abe K, Toriyabe S. Comparison of patient-controlled epidural analgesia with and without background infusion after gastrectomy. Anesth Analg 1998; 87: 907–10.
Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards. Prospective experience with 1,030 surgical patients. Anesthesiology 1998; 88: 688–95.
Hopkins D, Shipton EA, Potgieter D, et al. Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery. Can J Anaesth 1998; 45: 435–42.
O’Neil G, Paech M, Wood F. Preliminary clinical use of a patient-controlled intranasal analgesia (PCINA) device. Anaesth Intensive Care 1997; 25: 408–12.
Striebel HW, Koenigs D, Krämer J. Postoperative pain management by intranasal demand-adapted fentanyl titration. Anesthesiology 1992; 77: 281–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
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
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03020955