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A history of neuraxial administration of local analgesics and opioids

  • S. Brill (a1), G. M. Gurman (a1) and A. Fisher (a1)



The history of intrathecal and epidural anaesthesia is in parallel with the development of general anaesthesia. As ether anaesthesia (1846) is considered the first modern anaesthetic since its use by Morton 157 yr ago, so Bier made history by using cocaine for intrathecal anaesthesia in 1898. The first published report on opioids for intrathecal anaesthesia belongs to a Romanian surgeon, Racoviceanu-Pitesti, who presented his experience at Paris in 1901. It was almost a century before the opioids were used for epidural analgesia. Behar and his colleagues published the first report on the epidural use of morphine for the treatment of pain in The Lancet in 1979. Epidural and intrathecal opioids are today part of a routine regimen for intra- and postoperative analgesia. Over the last 30 yr, the use of epidural opioids has became a standard for analgesia in labour and delivery, and for the management of chronic pain. Finally, epidural opioids have been shown to have a pre-emptive effect, when used before major surgery. We present the evolution of neuraxial anaesthesia and the history of intrathecal and epidural administration of opioids.


Corresponding author

Correspondence to: Silviu Brill, Division of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84101, Israel. E-mail:; Tel: +972 8 6400262; Fax: +972 8 6423765


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Bonica JJ. History of pain concepts and pain therapy. Sem Anesth 1985; 4: 189208.
Cotugno DFA. De ischiade nervosa commentarius. Naples, Italy: Fratres Simonis, 1764.
Magendie F. Experiences sur les fonctions des racines des nerfs rachidiens. J Physiol Exper Path 1822; 2: 276279.
Rynd F. Neuralgia – introduction of fluid to the nerve. Dublin Med Press 1845; 13: 167168.
Pravaz C-G. Sur un nouveau moyen d'opérer la coagulation du sang dans les artères, applicable à la guérison des aneurismes. Compt Rend Acad Sci (Paris) 1853; 36: 8889.
Wood A. New method of treating neuralgia by the direct application of opiates to the painful points. Edin Med Surg J 1855; 82: 265281.
Becker HK. Carl Koller and cocaine. Psychoanal Quart 1963; 32: 309373.
Koller C. On the use of cocaine for producing anaesthesia on the eye. Lancet 1884; 2: 990993.
Wynter WE. Four cases of tuberculous meningitis in which paracentesis of the theca vertebralis was performed for the relief of fluid pressure. Lancet 1891; 1: 981982.
Quincke H. Die Lumbalpunction des Hydrocephalus. Berlin Klinische Wochenschrift 1891; 28: 929933.
Bier A. Versuche über Cocainisirung des Rückenmarkes. Deutsche Zeitschrift fur Chirurgie. 1899; 51: 361369.
Matas R. Local and regional anesthesia with cocaine and other analgesic drugs, including the subarachnoid method, as applied in general surgical practice. Philadelph Med J 1900; 6: 820843.
Jonnesco T. Quatre cas d'analgésie par injection de cocaine dans le sac lombaire. Bulletin et Memoires de la Société de Chirurgie de Bucharest 1900; II: 118119.
Jonnesco T. La rachianesthésie générale. Paris, France: Masson, 1919.
Barker AE. Clinical experience with spinal analgesia in 100 cases and some reflections on the procedure. BMJ 1907; 1: 665674.
Adriani J, Roman-Vega D. Saddle block anesthesia. Am J Surg 1946; 71: 12.
Corning JL. Spinal anesthesia and local medication of the cord. NY Med J 1885; 42: 483485.
Soresi AL. Episubdural anesthesia. Anesth Analg 1937; 16: 306310.
Curelaru I, Sandu L. Eugen Bogdan Aburel, the pioneer of regional analgesia for pain relief in childbirth. Anaesthesia 1982; 37: 663669.
Lemmon WT. A method for continuous spinal anesthesia. Ann Surg 1940; 111: 141.
Tuohy EB. Continuous spinal anesthesia: its usefulness and technic involved. Anesthesiology 1944; 5: 142148.
Cathelin MF. Une nouvelle voie d'injection rachidienne. Méthode des injections epidurales pas le procédé du canal sacre. Comptes Rendus des L'Société de Biologie. Paris, 1901; 53: 452455.
Pagés F. Anestesia metamerica. Revista de Sanidad de Militar Argentina 1921; 11: 351365.
Dogliotti AM. A new method of block anesthesia. Segmental peridural spinal anesthesia. Am J Surg 1933; 20: 107118.
Gutierrez A. Valor de la aspiración líquida en el espacio peridural en la anestesia peridural. Rev Circ Buenos Aires 1933; 12: 225.
Bromage PR. Epidural Anesthesia. Philadelphia, USA: WB Saunders, 1978.
Kreis O. Ueber Medullarnarkose bei Gebärenden. Zentralblatt fur Gynakologie 1900; 24: 724729.
Hopkins GS. Anesthesia by cocainization of the spinal cord. Philadelph Med J 1900; 6: 864.
Cristea I. Un secol de anestezie spinala in Romania. Bucharest, Romania: Editura Sylvia, 1999.
Aburel E. L'anesthésie locale continue (prolongée) en obstétrique. Bull Soc Obstet Gynecol 1931; 20: 3537.
Manalan SA. Caudal block anesthesia in obstetrics. J Indiana State Med Assoc 1942 35: 564565.
Edwards WB, Hingson RA. Continuous caudal anesthesia in obstetrics. Am J Surg 1942; 57: 459467.
Boccaccio G. The Decameron. Fourth Day. London, UK: Penguin Classics, 1998.
Rey R. A History of Pain. Paris, France: Editure La Découverte, 1993.
Serturner FWA. J Pharmazeutischen und Apoth Chemie. 1806; 14: 17.
Racoviceanu-Pitesti N. Anesthesia generala prin cocaina. Revista de Chirurgie 1900; IV: 1122.
Tuffier T. Analgésie chirurgicale par l'injection sous-arachnoidienne lombaire de cocaine. Comptes Rendus des Sociétés de Biologie 11th Series, 1899; 1: 882.
Matsuki A, Nothing new under the sun – a Japanese pioneer in the clinical use of intrathecal morphine. Anesthesiology 1983; 58: 289290.
Goldstein A, Lowney LI, Pal PK. Stereospecific and nonspecific interactions of the morphine congener levorphanol in subcellular fractions of mouse brain. Proc Nat Acad Sci USA 1971; 68: 17421747.
Pert C, Snyder S. Opiate receptor: demonstration in nerve tissue. Science 1973; 179: 10111014.
Yaksh TL, Rudy TA. Analgesia mediated by a direct spinal action of narcotics. Science 1976; 192: 13571358.
Yaksh TL. In vivo studies on spinal opiate receptor systems mediating antinoception. Mu and delta receptor in the primate. J Pharm Exper Therap 1983; 226: 303312.
LaMotte C, Pert CB, Snyder SH. Opiate receptor binding in primate spinal cord: distribution and changes after dorsal root section. Brain Res 1976; 112: 407412.
LaMotte RH, Campbell JN. Comparison of responses of warm and nociceptive C-fiber afferents in monkey with human judgments of thermal pain. J Neurophysiol 1978; 41: 509528.
Eisleb VO, Schaumann O. Dolantin, ein neuartiges spasmolytikum und analgetykum (chemisches und pharmacologisches). Deutsche Med Wochenschrift 1939; 65: 967968.
Mircea N, Constantinescu D, Jianu C, et al. Anesthésie sous-arachnoidienne par la péthidine. Ann Françaises Anesth Reanim 1982; 1: 167171.
Cousins MJ, Mather LE, Gourlay GK. Axon, spinal cord and Brain: targets for acute pain control. In: Scott DB, McClure J, Wildsmith JA, eds. Regional Anaesthesia 1884–1984. Denmark: J. H. Schultz, 1984.
Pasqualucci V, Moricca G, Solinas P. Intrathecal morphine for the control of the pain of myocardial infarction. Anaesthesia 1981; 36: 6869.
Behar M, Magora F, Olshwang D, Davidson JT. Epidural morphine in treatment of pain. Lancet 1979; 1: 527529.
Wang JK, Nauss LE, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology 1979; 50: 149151.
Cousins MJ, Mather E. Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61: 276310.
Bromage PR, Camporesi EM, Durant PAC, Nielsen CH. Rostral spread of epidural morphine. Anesthesiology 1982; 56: 431436.
Scott PV, Bowen FE, Cartwright P, et al. Intrathecal morphine as sole analgesic during labour. BMJ 1980; 2: 351355.
Sjostrom S, Hartvig D, Tamsen A. Patient-controlled analgesia with extradural morphine or pethidine. Brit J Anaesth 1988; 60: 358366.
Reiz S, Ahlin J, Ahrenfeldt B, Andersson M, Andersson S. Epidural morphine for postoperative pain relief. Acta Anaesth Scand 1981; 25: 111114.
Hjortso E, Vester-Andersen T, Moller IW, Lunding M. Epidural morphine for postoperative pain relief. Acta Anaesth Scand 1982; 26: 528530.
Gray HT, Parsons L. Blood pressure variations associated with lumbar puncture and the induction of spinal anesthesia. Q J Med 1912; 5: 339.
Labat G. Circulatory disturbances associated with subarachnoid nerve block. Long Island Med J 1927; 21: 573.
Butterworth JF, Piccione Jr W, Berrizbeitia LD, Dance G, Shenim RJ, Cohn LH. Augmentation of venous return by adrenergic agonists during spinal anesthesia. Anesth Analg 1986; 65: 612616.
Liolios A, Andersen FH. Selective spinal analgesia. Lancet 1979; 2: 357.
Glynn CJ, Mather LE, Cousins MJ, Wilson PR, Graham JR. Spinal narcotics and respiratory depression. Lancet 1979; 2: 356357.
Davies GK, Tolhurst-Cleaver CL, James TL. CNS depression from intrathecal morphine. Anesthesiology 1980; 52: 280.
Reiz S, Westberg M. Side effects of epidural morphine. Lancet 1980; 2: 203204.
Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Brit J Anaesth 1982; 54: 479485.
Morgan M. Intrathecal and epidural opiates: an assessment. Anaesthesia 1982; 37: 365366.
Morgan M. The rational use of intrathecal and extradural opioids. Brit J Anaesth 1989; 63: 165188.
Myint Y, Bailey PW, Milne BR. Cardiorespiratory arrest following combined spinal epidural anaesthesia for caesarean section. Anaesthesia 1993; 48: 684686.
Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain 1988; 33: 149160.
Moreno LA, Sinche M, Balust J, et al. Total spinal block (TSB) treated by means of cerebrospinal fluid rechange (CSFR). Int Mon Reg Anesth 1993; 68: 7881.
Kaiser KG, Bainton CR. Treatment of intrathecal morphine overdose by aspiration of cerebrospinal fluid. Anesth Analg 1987; 66: 475477.


A history of neuraxial administration of local analgesics and opioids

  • S. Brill (a1), G. M. Gurman (a1) and A. Fisher (a1)


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