Melatonin Improves Tourniquet Tolerance and Enhances Postoperative Analgesia in Patients Receiving Intravenous Regional Anesthesia

Abstract

Melatonin is an effective premedication before IVRA since it reduced patient anxiety, decreased tourniquet-related pain, and improved perioperative analgesia.

A systematic review of peri‐operative melatonin

“…Participants had various operations: abdominal [15][16][17]25, Full-text studies excluded (n = 17) -10 studies did not investigate surgical patients -3 studies were protocol studies -2 studies were not randomised -2 studies used melatonin only in combination with other drug interventions 32]; dental [27]; gynaecological [5,6,18,19,30]; ophthalmological [4,14]; orthopaedic [12]; thoracic [28,29]; urological [13]; vascular [26]; and mixed [20][21][22][23][24]31]. The anaesthetic techniques included: general anaesthesia [13,[15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32]; intravenous regional anaesthesia [12]; neuraxial block [5,6,20,26,31]; sedation …”

“…Pain was investigated by 12 RCTs (n = 821) as scores [16,17,20], analgesic requirements [15], or both [4-6, 12-14, 18, 19]. Pain scores were documented with a visual analogue scale (VAS) [5,6,13,[16][17][18][19], verbal score [4,12,14] or numerical rating scale (NRS) [20] (Table 3). Melatonin reduced postoperative pain (Fig.…”

Efficacy and Safety of Melatonin as an Anxiolytic and Analgesic in the Perioperative Period

“…25 The tabular data for melatonin premedication was available in only four studies (table 4) and other studies published only graphical data. 23,28,29,32 The baseline anxiety in the control and melatonin groups was similar. However, a statistically significant reduction in anxiety scores was achieved 50 -90 min after melatonin administration in four studies.…”

“…The anesthetic technique included general anesthesia, regional anesthesia (epidural, spinal, Bier block), and local anesthesia with or without sedation. The exogenous melatonin dose ranged from 3 to 15 mg and was administered 50 -90 min preoperatively via an oral [23][24][25][27][28][29]32 or sublingual route. 26,30,31 Three studies followed a dual regime of melatonin administration in which an additional dose of melatonin was administered on the night before surgery.…”

Melatonin: pregnancy and labor

“…Поэтому предлагается использовать мелатонин для премедикации [52] и болезненных сокращениях миометрия [32,37]. Мелатонин с целью обезболивания уже успешно используется в интенсивной терапии новорожден-ных детей [37], а его применение в анестезиоло-гической практике позволяет значительно снизить дозировку необходимых для наркоза препаратов и обеспечить анксиолитический и противовоспа-лительный эффекты в послеоперационном перио-де [28,41,64,69,70,94,98,111].…”