Abstract
Purpose
Our intention was to assess the effectiveness of preoperative oral melatonin medication on sedation, sleep quality, and postoperative analgesia in patients undergoing elective prostatectomy.
Methods
Fifty-two ASA I–II patients undergoing elective prostatectomy were included in this study, randomly divided into two groups. Patients received an oral placebo (n = 26) or 6 mg melatonin (n = 26) the night before and 1 h before surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol i.v. via a PCA device. Extubation time, intraoperative fentanyl consumption, and recovery time were assessed at the end of the operation. Pain scores, tramadol consumption, and sedation scores were assessed at 1, 2, 4, 6, 12, 18, and 24 h postoperatively, and sleep quality and subjective analgesic efficacy were assessed at 24 h after surgery.
Results
There were no significant differences in demographic data between the groups. Extubation time and recovery time from anesthesia were significantly longer in the melatonin group (P < 0.05). Intraoperative fentanyl usage, pain scores, and tramadol consumption were significantly lower in the melatonin group (P < 0.05). The postoperative sleep quality of patients was significantly better in the melatonin group than in the control group (P < 0.05). Postoperative VAS of pain was significantly lower in the melatonin group compared with the control group at 1, 2, 4, 6, 12, 18, and 24 h postoperatively (P < 0.05). Subjective analgesic efficacy of patients was significantly different between groups (P < 0.05). The sedation scores were significantly higher in the melatonin group than in the control group at 1 h and 2 h after surgery (P < 0.05).
Conclusions
Preoperative oral melatonin administration decreased pain scores and tramadol consumption and enhanced sleep quality, sedation scores, and subjective analgesic efficacy during the postoperative period.
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References
Rawal N, Berggen L. Organization of acute pain services: a low cost model. Pain. 1994;57:117–23.
Pacchierotti C, Lapichino S, Bossini L, Pieraccini F, Castrogiovanni P. Melatonin in psychiatry disorders: a review on the melatonin involvement in psychiatry. Front Neuroendocrinol. 2001;22:18–32.
Basket JJ, Cockrem JF, Todd MA. Melatonin levels in hospitalized elderly patients: a comparison with community based volunteers. Age Ageing. 1991;20:430–4.
Tzischinsky O, Laive P. Melatonin possesses time-dependent hypnotic effects. Sleep. 1994;17:638–45.
Naguib M, Samarkandi AH. Premedication with melatonin: a double blind, placebo controlled comparison with midazolam. Br J Anaesth. 1999;82:875–80.
Weaver DR, Stehle JH, Stopa EG, Reppert SM. Melatonin receptors in human hypothalamus and pituitary: implications for circadian and reproductive responses to melatonin. J Clin Endocrinol Metab. 1993;76:295–301.
Tan DX, Reiter RJ, Manchester LC, Yan MT, El-Sawi M, Sainz RM, Mayo JC, Kohen R, Allegra M, Hardeland R. Chemical and physical properties and potential mechanisms: melatonin as a broad spectrum antioxidant and free radical scavenger. Curr Top Med Chem. 2002;2:181–97.
Yu CX, Zhu CB, Xu SF, Cao XD, Wu GC. The analgesic effects of peripheral and central administration of melatonin in rats. Eur J Pharmacol. 2000;403:49–53.
Soppit AJ, Glass PS, El-Moalem H, Ginsberg B, Weatherwax K, Gan TJ. Duration and recovery profile of cisatracurium after succinylcholine during propofol or isoflurane anesthesia. J Clin Anesth. 1999;11:652–6.
Webb AR, Leong S, Myles PS, Burn SJ. The addition of a tramadol infusion to morphine patient-controlled analgesia after abdominal surgery: a double-blinded, placebo-controlled randomized trial. Anesth Analg. 2002;95:1713–8.
Ebadi M, Govitrapong P, Phansuwan-Pujito P, Nelson F, Reiter RJ. Pineal opioid receptors and analgesic action of melatonin. J Pineal Res 1998;24:193–200.
Reiter RJ, Calvo JR, Karbownik M, Qi W, Tan DX. Melatonin and its relation to the immune system and inflammation. Ann NY Acad Sci. 2000;917:376–86.
Golombek DA, Escolar E, Burin LJ, De Brito Sánchez MG, Cardinali DP. Time-dependent melatonin analgesia in mice: inhibition by opiate or benzodiazepine antagonism. Eur J Pharmacol. 1991;194:25–30.
Shavali S, Ho B, Govitrapong P, Sawlom S, Ajjimaporn A, Klongpanichapak S, Ebadi M. Melatonin exerts its analgesic actions not by binding to opioid receptor subtypes but by increasing the release of beta-endorphin, an endogenous opioid. Brain Res Bull. 2005;64:471–9.
Karkela J, Vakkuri O, Kaukinen S, Huang WQ, Pasanen M. The influence of anaesthesia and surgery on the circadian rhythm of melatonin. Acta Anaesthesiol Scand. 2002;46:30–6.
Frink EJ Jr, Malan TP, Atlas M, Dominguez LM, DiNardo JA, Brown BR Jr. Clinical comparison of sevoflurane and isoflurane in healthy patients. Anesth Analg. 1992;74:241–5.
Hanania M, Kitain E. Melatonin for treatment and prevention of postoperative delirium. Anesth Analg. 2000;94:338–9.
Gogenur I, Rosenberg J. Sleep disturbances after non-cardiac surgery. In: Lee-Chiong T, editor. Sleep: a comprehensive handbook. Hoboken: Wiley; 2006. p. 913–25.
Closs SJ. Patient’s night-time pain, analgesic provision and sleep after surgery. Int J Nurs Stud. 1992;29:381–92.
Chassard D, Duflo F, Bouvet L, Boselli E. Chronobiology of postoperative pain: it’s time to wake up!. Can J Anesth. 2007;54:685–8.
Phillips GD, Cousins MJ. Neurological mechanisms of pain and the relationship of pain, anxiety and sleep. Acute pain management. New York: Churchill Livingstone; 1986. p. 21–48.
Wan Q, Man HY, Liu F, Braunton J, Niznik HB, Pang SF, Brown GM, Wang YT. Differential modulation of GABAA receptor function by Mel 1a and Mel 1b receptors. Nat Neurosci. 1999;2:401–3.
Naguib M, Samarkandi AH. The comparative dose-response effect of melatonin and midazolam for premedication of adult patients: a double-blinded placebo-controlled study. Anesth Analg. 2000;91:473–9.
Caumo W, Torres F, Moreira NL, Auzani JA, Monteiro CA, Londero G, Ribeiro DF, Hidalgo MP. The clinical impact of preoperative melatonin on postoperative outcomes in patients undergoing abdominal hysterectomy. Anesth Analg. 2007;105:1263–71.
Wurtman RJ, Zhdanova IV. Improvement of sleep quality by melatonin. Lancet. 1995;346:1491–2.
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We have no personal or financial relationships that have any potential to inappropriately influence (bias) our actions or the manuscript, and no financial or other potential conflicts of interest exist (including involvement with any organization with a direct financial, intellectual, or other interest in the subject of the manuscript) regarding the manuscript.
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Borazan, H., Tuncer, S., Yalcin, N. et al. Effects of preoperative oral melatonin medication on postoperative analgesia, sleep quality, and sedation in patients undergoing elective prostatectomy: a randomized clinical trial. J Anesth 24, 155–160 (2010). https://doi.org/10.1007/s00540-010-0891-8
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DOI: https://doi.org/10.1007/s00540-010-0891-8