title: Comparative study in patients with symptomatic internal derangements of the temporomandibular joint: analgesic outcomes of arthrocentesis with or without intra-articular morphine and tramadol.
abstract: Our aim was to find out whether pain was better controlled if morphine or tramadol was injected intra-articularly after arthrocentesis with Ringer's lactate in patients with painful temporomandibular joints (TMJ). This placebo-controlled, double-blind study involved 30 patients who had not responded to conservative treatment and who were divided randomly into 3 groups of 10 patients each. All patients had arthrocentesis, and the drugs were given as intra-articular injections immediately after the procedure. One group was give 5% Ringer's lactate 1ml, the second morphine 1mg, and the third tramadol 50mg. Visual analogue scales (VAS) for pain were recorded at maximum mouth opening and at rest before intra-articular injection and after 15 and 30min; at 1, 2, 3, 8, 12, 24, 36 and 48h; and at 1, 3, and 6 monthly follow-up. The mean (SD) VAS decreased from 6.90 (1.45) to 2.6 (2.5) in the control group, from 7.30 (1.64) to 1.20 (0.79) in the morphine group (p=0.005), and from 7.10 (1.73) to 1.50 (1.78) in the tramadol group (p=0.005). We conclude that morphine given by intra-articular injection after arthrocentesis gives a significant, sustained (6 months) improvement in pain relief compared with simple arthrocentesis alone. The effect was similar with tramadol except that it was shorter lived.
authors.affiliation: Department of Oral & Maxillofacial Surgery, University of Marmara, School of Dentistry, Istanbul, Turkey. Electronic address: aysegulsipahi@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Sipahi
authors.affiliation: Department of Oral & Maxillofacial Surgery, University of Marmara, School of Dentistry, Istanbul, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Satilmis
authors.affiliation: Department of Oral & Maxillofacial Surgery, University of Marmara, School of Dentistry, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Basa
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000069237:Arthrocentesis / Q000379:methods*; D004311:Double-Blind Method; D005157:Facial Pain / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000379:methods; D010894:Piroxicam / Q000008:administration & dosage / Q000031:analogs & derivatives; D010919:Placebos; D016059:Range of Motion, Articular / Q000187:drug effects; D000077325:Ringer's Lactate; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy*; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007552:Isotonic Solutions; D010919:Placebos; D000077325:Ringer's Lactate; D010894:Piroxicam; D014147:Tramadol; D009020:Morphine; C032801:tenoxicam
keywords: Analgesia; Arthrocentesis; Injections; Intraarticular; Morphine; TMJ; Tramadol