Preoperative oral melatonin can reduce preoperative anxiety and postoperative analgesia in a dose-dependent manner

Abstract

Background Preoperative anxiety has deleterious effects on patients’ outcome through its influence on intraoperative requirements of anesthetics and analgesics (Bayrak et al., J Coll Physicians Surg Pak 29:868–873, 2019), postoperative (PO) pain intensity, and analgesia requirement, and may even increase PO morbidity and mortality after certain types of surgery. Melatonin is a methoxyindole synthesized and secreted principally by the pineal gland at night under control of an endogenous rhythm of secretion generated by the suprachiasmatic nuclei. The current study hypothesized that preoperative melatonin could reduce patients’ anxiety and reduce intraoperative (IO) and postoperative (PO) analgesic in a dose-dependent manner. Results Preoperative consultation was, to some extent, effective in reducing patients’ anxiety and apprehension. At 1 h after receiving premedication, Anxiety Specific to Surgery Questionnaire (ASSQ) scores were significantly lower in study groups in comparison to baseline scores and at 1 h scores of P group patients (patients who received 3 ml of plain distilled water), and this significant effect extended for 3-h PO. The reported ∆∆ASSQ between study groups was 25.9% between M2 (melatonin) and Z (midazolam) groups and 36.9% between groups M1 (received melatonin in a dose of 3 mg) and M2 (received melatonin in a dose of 6 mg). Preoperative anxiolytic therapy allowed reduction of PO pain scores and analgesia consumption with prolongation of duration till 1st request of rescue analgesia, and these effects were more pronounced with melatonin 6 mg in comparison to placebo, melatonin 3mg, or midazolam. Conclusion Preoperative melatonin is an appropriate policy for reduction of preoperative anxiety and provided reduction of PO anxiety, pain scores, and consumption of analgesia thus promoting early recovery and short PO hospital stay. Dose dependency was evident, and preoperative melatonin 6-mg dose provided satisfactory effect.

Assessing the Premedication Properties of Sublingual Melatonin in Young Women Undergoing Cesarean Section With Spinal Anesthesia: A Double-Blind Randomized Study

“…Our findings regarding the analgesic effect of melatonin align with earlier studies, further supporting the efficacy of melatonin as a premedication agent [ 3 , 9 , 11 - 13 ]. The results of studies by Khare et al [ 14 ] and Lotfy and Ayaad [ 15 ] align with that of the current study. Khare et al discovered that premedication with oral melatonin (6 mg) serves as an effective alternative to alprazolam, offering improved anxiolysis, less sedation, and maintenance of cognitive and psychomotor function [ 14 ].…”

Role of oral melatonin in prevention of postoperative delirium in patients undergoing elective surgery under general anesthesia: A Randomized controlled trial

“…So, supplementing melatonin maintains the melatonin levels in body and leads to good sleep, decreases the incidence of postoperative delirium, and preserves the cognitive functions in the postoperative period. [ 18 19 ] These findings suggest melatonin should be included as one of the premedications a day before the surgery to reduce the incidence of delirium in patients undergoing surgery.…”

Behavioral and cardiovascular effects of a single dose of gabapentin or melatonin in cats: a randomized, double-blind, placebo-controlled trial

“…Regarding melatonin, its use in dogs before anesthesia reduces the induction dose of propofol. 13 Additionally, melatonin’s action may be more potent with a longer interval, a higher dose, 46 combined with gabapentin 47 or with a preceding administration.…”