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Canadian Journal of Anesthesia

, Volume 47, Issue 4, pp 367–374 | Cite as

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

  • Gillian R. Hamilton
  • Thomas F. BAskett
History Of Anesthesia

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.

Keywords

Morphine Opium Opioid Receptor Postoperative Analgesia Saffron 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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.

References

  1. 1.
    Tallmadge GK. Some anesthetics of antiquity. J Hist Med Allied Sci 1946; 1: 515–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Dwarakanath SC. Use of opium and cannabis in traditional systems of medicine in India. Bull Narc 1965; 17: 15–9.Google Scholar
  3. 3.
    Gunther RT. The Greek Herbal of Dioscorides, Book IV. London: Hafner Publishing Company, 1968: 473.Google Scholar
  4. 4.
    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.Google Scholar
  5. 5.
    Bergman NA. The Genesis of Surgical Anesthesia. Park Ridge: Wood Library-Museum of Anesthesiology, 1998: 18.Google Scholar
  6. 6.
    Sigerist He. Laudanum in the works of Paracelsus. Bull Hist Med 1941; 9: 530–44.Google Scholar
  7. 7.
    Macht DI. The history of opium and some of its preparations and alkaloids. JAMA 1915; 64: 477–81.Google Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    Bell B. A system of Surgery, 6th ed., Vol. 2. Edinburgh: Bell and Bradfute, 1796: 393–7.Google Scholar
  10. 10.
    McDowell E. Three cases of extirpation of diseased ovaria. Eclect Rep Analyt Rev (Philadelphia) 1817, 7: 242–4.Google Scholar
  11. 11.
    McDowell E. Observations on diseased ovaria. Eclect Rep Analyt Rev (Philadelphia) 1819; 9: 546–53.Google Scholar
  12. 12.
    Shoemaker JV. Materia Medica and Therapeutics, Vol 2. Philadelphia, 1891: 785.Google Scholar
  13. 13.
    Serturner FW. Trommsdorff’s Journal der Pharmazie fur Aerzte, Apotheker und Chemisten 1805; 13: 229–35.Google Scholar
  14. 14.
    Serturner FW. Trommsdorff’s Journal der Pharmazie fur Aerzte, Apotheker und Chemisten 1806; 14: 47–93.Google Scholar
  15. 15.
    Lockemann J. On Serturner. J Chem Educ 1951; 28: 277.Google Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.Google Scholar
  18. 18.
    Gregory W. On a process of preparing economically the muriate of morphia. Edin Med Surg J 1831; 35: 331–8.Google Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    Lafargue GV. Note sur les effets de quelques medicaments introduits sous l’epiderme. Acad Sci Paris 1836; 2: 397–8, 434.Google Scholar
  21. 21.
    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.Google Scholar
  22. 22.
    Rynd F. Neuralgia- introduction of fluid to the nerve. Dublin Med Press 1845; 13: 167–8.Google Scholar
  23. 23.
    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.Google Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    Hunter C. On narcotic injections in neuralgia. Med Times Gazette 1858; 2: 408–9.Google Scholar
  26. 26.
    Hunter C. On narcotic injections in neuralgia. Med Times Gazette 1858; 2: 457–8.Google Scholar
  27. 27.
    Wood A. Treatment of neuralgic pains by narcotic injections. BMJ 1858; 1: 721–3, 755.Google Scholar
  28. 28.
    Hunter C. Practical remarks on the hypodermical treatment of disease. Lancet 1863; 2: 444–5, 675–6.CrossRefGoogle Scholar
  29. 29.
    Howard-Jones N. A critical study of the origins and early development of hypodermic medication. J Hist Med 1947; 2: 201–49.Google Scholar
  30. 30.
    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.PubMedGoogle Scholar
  31. 31.
    Stein C, Schäfer M, Hassan AHS. Peripheral opioid receptors. Ann Med 1995; 27: 219–21.PubMedCrossRefGoogle Scholar
  32. 32.
    Paget J. Subcutaneous injection of morphia after operation, before restoration of consciousness after chloroform. Lancet 1863; 1: 48.Google Scholar
  33. 33.
    Corning JL. Spinal anaesthesia and local medication of the cord. NY Med J 1885; 42: 483–5.Google Scholar
  34. 34.
    Vandam LD. On the origins of intrathecal anesthesia. Reg Anesth Pain Med 1998; 23: 335–9.PubMedCrossRefGoogle Scholar
  35. 35.
    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.)Google Scholar
  36. 36.
    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.Google Scholar
  37. 37.
    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.Google Scholar
  38. 38.
    Pert CB, Snyder SH. Opiate receptor: demonstration in nervous tissue. Science 1973; 179: 1011–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Kuhar MJ, Pert CB, Snyder SH. Regional distribution of opiate receptor binding in monkey and human brain. Nature 1973; 245: 447–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Snyder SH. Opiate receptors in the brain. N Engl J Med 1977; 296: 266–71.PubMedGoogle Scholar
  41. 41.
    Snyder SH. Opiate receptors and internal opiates. Sci Am 1977; 236: 44–56.PubMedCrossRefGoogle Scholar
  42. 42.
    Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science 1976; 192: 1357–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Wang YK. Soulagement de la douleur par injection intrathécale de sérotonine ou de morphine. Annals Anesth Fr 1978; 19: 371–2.Google Scholar
  44. 44.
    Sicard JA. Les injections medicamenteuses extradurales par voie sacro-coccygienne. Compte Rend Soc de Biol 1901; 53: 396–8.Google Scholar
  45. 45.
    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.Google Scholar
  46. 46.
    Behar M, Magora F, Olshwang D, Davidson JT. Epidural morphine in treatment of pain. Lancet 1979; 1: 527–30.PubMedCrossRefGoogle Scholar
  47. 47.
    Bromage PR, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgeisa. Anesth Analg 1980; 59: 473–80.PubMedCrossRefGoogle Scholar
  48. 48.
    Reiz S, Ahlin J, Ahrenfeldt B, Andersson M, Andersson S. Epidural morphine for postoperative pain relief. Acta Anaesthesiol Scand 1981; 25: 111–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Rawal N, Sjörstrand U, Dahlström B. Postoperative pain relief by epidural morphine. Anesth Analg 1981; 60: 726–31.PubMedCrossRefGoogle Scholar
  50. 50.
    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.CrossRefGoogle Scholar
  51. 51.
    Streisand JB, Hague B, van Vreeswijk H, et al. Oral transmucosal fentanyl premedication in children. Anesth Analg 1987; 66: S170.Google Scholar
  52. 52.
    Vincenti E. Sublingual opiates in acute pain. Adv Pain Res Ther 1990; 14: 227–31.Google Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    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.PubMedCrossRefGoogle Scholar
  55. 55.
    Raper HR. Man Against Pain. The Epic of Anesthesia. New York: Prentice-Hall, Inc., 1945; 212–3.Google Scholar
  56. 56.
    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.PubMedGoogle Scholar
  57. 57.
    Sechzer PH. Objective measures of pain and pain relief following cardiovascular surgery. Rev Argent Angiol 1967; 1: 9–12.Google Scholar
  58. 58.
    Rawal N. Epidural and spinal agents for postoperative analgesia. Surg Clin North Am 1999; 79: 313–44.PubMedCrossRefGoogle Scholar
  59. 59.
    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.PubMedCrossRefGoogle Scholar
  60. 60.
    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.PubMedCrossRefGoogle Scholar
  61. 61.
    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.PubMedGoogle Scholar
  62. 62.
    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.PubMedGoogle Scholar
  63. 63.
    Striebel HW, Koenigs D, Krämer J. Postoperative pain management by intranasal demand-adapted fentanyl titration. Anesthesiology 1992; 77: 281–5.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Gillian R. Hamilton
    • 1
  • Thomas F. BAskett
    • 1
  1. 1.From the Department of Obstetrics and GynaecologyDalhousie UniversityHalifaxCanada

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