The use of intra-articular opioids and bupivacaine for analgesia following temporomandibular joint arthroscopy: a prospective, randomized trial.
OBJECTIVE
This investigation evaluated the efficacy of using intra-articular morphine, bupivacaine, or a combination of both in the management of postarthroscopy temporomandibular joint (TMJ) pain.


METHODS
Thirty-two consecutive patients with internal derangements of the TMJ and persistent pain underwent TMJ arthroscopy. The patients were randomized equally into 4 groups. Group 1 received a sterile saline solution (control), group 2 received bupivacaine alone, group 3 received only a morphine solution, and group 4 received morphine mixed with bupivacaine. The patients recorded postarthroscopy pain using a visual analog scale (VAS), as well as analgesic consumption for 24 hours. The VAS and analgesic consumption were compared in the 4 groups.


RESULTS
Group 3 (bupivacaine alone) consumed, on average, 5.1 fewer analgesic equivalents than did group 1 (control) over the 24-hour period of study (P <.05). Otherwise, there was no significant difference in the number of analgesic equivalents consumed by the 4 groups. Patients treated with bupivacaine alone and those with morphine alone had significantly lower pain scores than the controls. However, there was no significant difference between the pain scores of the morphine and bupivacaine groups at any time. Patients treated with the mixture of morphine and bupivacaine showed no significant difference from controls at any time.


CONCLUSIONS
Bupivacaine alone provides a better analgesic effect than morphine alone or the combination of morphine and bupivacaine. Morphine alone has a longer time of onset, with less effect on the pain scores during the 24-hour observation period.
Furst
I M
IM
Division of Oral and Maxillofacial Surgery, Cambridge Memorial, Stratford, and Woodstock General Hospitals, Ontario, Canada. ianfurst@mobile.rogers.com
Kryshtalskyj
B
B
Weinberg
S
S
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D019647:Oral Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D013705:Temporomandibular Joint Disorders / Q000601:surgery*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D009020:Morphine; D002045:Bupivacaine