Intra-Articular Local Anesthetics in Temporomandibular Disorders: A Systematic Review and Meta-Analysis

Abstract

This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in relieving pain and increasing mandibular mobility. Randomized controlled trials were included with no limitation on report publication dates. Final searches were performed on 15 October 2023, using engines provided by the US National Library, Bielefeld University, and Elsevier Publishing House. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Articular pain and mandible abduction values and their mean differences were summarized in tables and graphs. Eight studies on a total of 252 patients evaluating intra-articular administration of articaine, bupivacaine, lidocaine, and mepivacaine were included in the systematic review. None of the eligible studies presented a high risk of bias in any of the assessed domains. An analgesic effect of intra-articular bupivacaine was observed for up to 24 h. In the long-term follow-up, there were no statistically significant changes in quantified pain compared to both the baseline value and the placebo group, regardless of the anesthetic used (articaine, bupivacaine, and lidocaine). There is no scientific evidence on the effect of intra-articular administration of local anesthesia on the range of motion of the mandible. Therefore, in the current state of knowledge, the administration of local anesthetics into the temporomandibular joint cavities can only be considered as a short-term pain relief measure.

Temporomandibular Joint Injections and Lavage: An Overview of Reviews

“…The advantage of using bupivacaine over placebo was observed in the first 24 h of follow-up only [11]. In more extended observations, local anesthetics do not provide a better effect than a placebo.…”

“…No better effect (Lubecka 2023 [11]) X AC-arthrocentesis; CS-corticosteroids; HA-hyaluronic acid; I-PRF-Injectable Platelet-Rich Fibrin; PRPplatelet-rich plasma. No better clinical outcomes (Leung 2020 [50])…”

“…Rinsing of the TMJs is performed as an independent procedure or precedes the injection of the active substance [9]. The most frequently used injectables include (1) hyaluronic acid, which is naturally the main component of synovial fluid, (2) autologous blood and centrifuged blood products, (3) anti-inflammatory drugs, (4) hypertonic dextrose irritant, and (5) local anesthetics [10][11][12][13][14][15].…”

Progress in the Study of Temporomandibular Joint Lavage in Temporomandibular Joint Disorder

“…For some common analgesics and anesthetics (bupivacaine, lidocaine, mepivacaine, and articaine), there was no statistically significant improvement in the range of motion of the jaw after local anesthesia was given in the joint, bupivacaine can provide temporary pain relief for up to 24 hours after injection and is currently only considered as a short-term pain relief measure after local intra-articular anesthesia. 55 Some scholars have studied the effect of Hyaluronic Acid (HA), Corticosteroids (CS) or Platelet-rich Plasma (PRP) injected at the time of lavage on the rehabilitation of patients. 56 The results show that there is no difference in the rehabilitation outcome after 2 years between the addition of HA or CS and the simple lavage, but it can reduce pain and inflammation for a month to 3 months after the irrigation is completed.…”