Data from related literature has suggested that arthrocentes

Data from related literature has suggested that arthrocentesis may be of some benefit to manage symptoms of TMDs. Such a technique was first introduced for the management of sudden onset of closed lock [3]. Arthrocentesis is the single most important non-invasive procedure in musculoskeletal medicine. Therapeutic arthrocentesis is the basic underlying procedure for intra-articular treatment, including; needle lavage and intra-articular injection of therapeutic substances [4]. One of these therapeutic substances is the hyaluronic phosphatidylinositol 4-kinase (HA), Exogenous (HA) can stimulate the synthesis of endogenous (HA)–forming synoviocytes of osteoarthritic joints, so reducing joint friction coefficient and decreasing risk of damage [5]. There is scientific and clinical evidence for the analgesic and anti-inflammatory properties of Intra-articular (IA) administered opioids; both in acute and chronic joint pain [6]. Intra-articular injection of opioids has been reported in various studies (Likar et al. [7] 1997; Gupta et al. [8] 2001; Kalso et al. [9] 2002), but according to current study, no survey has been made for the evaluation of fentanyl in TMJ intra-articular injection. Opioid agonists have powerful anti-inflammatory properties and they exert their action in the periphery via opioids receptors [10]. Fentanyl is a synthetic potent mu opioid receptor agonist characterized by both high potency and high lipid solubility; it is approximately 80 times more potent than morphine and binds strongly to plasma proteins [11,12].
Materials and methods All patients were subjected to: These parameters were recorded also at the following intervals postoperatively; immediate post-operative, one week, one month and six months after the procedure. The treated joints were divided randomly into two groups;
Results
Discussion Ever since pain pathways are understood by the clinicians, importance has been given for utilizing the peripheral narcotic receptors for management of pain Understanding, that opioids can elicit analgesic effects by acting on peripheral opioid receptors, has led to their experimentation in controlled clinical trials [43,44]. Peripheral opioid receptors may be activated only in the presence of tissue inflammation; also, opioid binding sites have been identified in synovial tissues indicating that analgesia is locally mediated. Opioid receptors are mostly located on the terminal end of the nerves and they are activated by inflammation; in this situation afferent ends of the nerves and leukocytes are the target sites. They have a longer analgesic effect in the intra-articular region compared with systemic administration [45–47]. Fentanyl being fat soluble opioid with less histamine release was proved in many studies to be more effective in intra-articular analgesia than morphine [43,48,49]; Histamine is a powerful activator of nociceptors in the local tissues and induces substance-P release. Histamine and substance P produce vasodilatation and increased vascular permeability, which lead to the release of bradykinin. Substance P promotes additional release of histamine from mast cells and serotonin from platelets [50,51]. Fentanyl being fat soluble opioid with less histamine release was proved in many studies to be more effective in intra-articular analgesia than morphine [43,48,49]. In accordance with current study results; Saryazdi et al. [52] found that better postoperative analgesia and less pain score were achieved by fentanyl and pethidine in comparison to dexamethasone but the results were not significantly different between fentanyl group and pethidine. Further article by Mandal et al. [49] concluded that although fentanyl is a short-acting narcotic drug, its IA administration provided prolonged postoperative analgesia. On the other hand; Uysalel et al. [53] concluded that a combination of intra-articular morphine and bupivacaine has a longer analgesic duration than a combination of fentanyl and bupivacaine for analgesia after arthroscopic surgery of the knee joint. Furthermore, on contrary to the present study; Manuar et al. [54] suggested that intra-articular ropivacaine gives better postoperative pain relief, with increased time of first analgesic request and decreased need of total postoperative analgesia compared to fentanyl and dexmedetomidine.