Document Type : Original Article
Authors
Anesthesiology, Critical Care, and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Abstract
Introduction: Melatonin is synthesized from the tryptophan amino acid in the pineal gland. Its role in Sleep was defined previously. Several studies have shown the effect of melatonin on postoperative pain and sedation. The aim of this study was to evaluate the effect of melatonin on postoperative pain in patients undergoing an appendectomy.
Methods: In a double-blind clinical trial, 64 patients aged 18-80 years with an ASA Ⅰ-Ⅱ anesthesia class who had been candidates for appendectomy with general anesthesia were enrolled. Patients were randomly divided into two groups’ melatonin and placebo (each group was 32). The first group received 6 mg of oral melatonin one hour before while the second group received a placebo. Before surgery and during the hours 2, 12, and 24 hours after surgery, patients' pain was measured based on the VAS. The patients' sedation was measured according to the Ramsay score and rescue analgesia was measured at the above time points. To analyze the data, SPSS software was used and the significance level was considered as P-value<0.05.
Results: The results of our study showed that pain levels in the melatonin group were lower in the 2nd, 12, and 24th hours after the surgery of the appendectomy than in the placebo group. Sedation rates were not significantly different between the two groups. The analgesic consumption was lower in the Melatonin group than in the placebo group.
Conclusion: Melatonin has a positive effect on the degree of pain (VAS) after an appendectomy.
Keywords
Main Subjects
- Tadayyonfar M, Amadani M, Tajabadi A, Tabaraee Y, Khosrojerdi H. Comparison of effect of promethazine and diclofenac on pain control of appendectomy surgery: a randomized clinical trial. J Sabzevar Univ Med Sci. 2016;23(1):14-20. [Persian].
- Koohestani HR, Baghcheghi N, Rezaei K. Comparison of satisfaction with post-operative pain management and level of functional interferance in addicted and non-addicted patients. J Holist Nurs Midwifery. 2014;24(3):48-55. [Persian].
- Momenzadeh S, Mohammadinasab H, Younesi Z, Sayadi M. Evaluation of patients’ satisfaction following postoperative acute pain management. J Iran Med Council. 2012;29(4):331- 7. [Persian].
- Lee W, Hahn K, Hur J, Kim Y. Effect of topical lidocaine patch on postoperative pain management in laparoscopic appendectomy: a randomized, double-blind, prospective study. J Laparoendosc Adv Surg Tech A. 2018;28(9):1061-7. doi: 10.1089/lap.2018.0013.
- Nesioonpour S, Mokmeli S, Vojdani S, Mohtadi A, Akhondzadeh R, Behaeen K, et al. The effect of low-level laser on postoperative pain after tibial fracture surgery: a double-blind controlled randomized clinical trial. Anesth Pain Med. 2014;4(3):e17350. doi: 10.5812/aapm.17350.
- Imani F, Rokhtabnak F, Radmehr M, Taherifard P. Evaluation of analgesic effect of adding magnesium to lidocaine in patient-controlled regional analgesia (PCRA) after foot surgery. J Anesth Pain. 2011;1(3):48-56. [Persian].
- Jan JE, Reiter RJ, Wong PK, Bax MC, Ribary U, Wasdell MB. Melatonin has membrane receptor-independent hypnotic action on neurons: an hypothesis. J Pineal Res. 2011;50(3):233- 40. doi: 10.1111/j.1600-079X.2010.00844.x.
- Babaei-Balderlou F, Illkhanipour M, Heidari R, Zare S, Bernousi I. Effect of melatonin on peripheral neuropathic pain in diabetic rat. Iran J Endocrinol Metab. 2009;11(1):79- 87. [Persian].
- Cardinali DP, Srinivasan V, Brzezinski A, Brown GM. Melatonin and its analogs in insomnia and depression. J Pineal Res. 2012;52(4):365-75. doi: 10.1111/j.1600- 079X.2011.00962.x.
- Arendt J, Rajaratnam SM. Melatonin and its agonists: an update. Br J Psychiatry. 2008;193(4):267-9. doi: 10.1192/bjp. bp.108.050955.
- Borazan H, Tuncer S, Yalcin N, Erol A, Otelcioglu S. Effects of preoperative oral melatonin medication on postoperative analgesia, sleep quality, and sedation in patients undergoing elective prostatectomy: a randomized clinical trial. J Anesth. 2010;24(2):155-60. doi: 10.1007/s00540-010-0891-8.
- Caumo W, Levandovski R, Hidalgo MP. Preoperative anxiolytic effect of melatonin and clonidine on postoperative pain and morphine consumption in patients undergoing abdominal hysterectomy: a double-blind, randomized, placebo-controlled study. J Pain. 2009;10(1):100-8. doi: 10.1016/j.jpain.2008.08.007.
- Beigom Khezri M, Merate H. The effects of melatonin on anxiety and pain scores of patients, intraocular pressure, and operating conditions during cataract surgery under topical anesthesia. Indian J Ophthalmol. 2013;61(7):319-24. doi: 10.4103/0301-4738.99637.
- Kücükakin B, Wilhelmsen M, Lykkesfeldt J, Reiter RJ, Rosenberg J, Gögenur I. No effect of melatonin to modify surgical-stress response after major vascular surgery: a randomised placebo-controlled trial. Eur J Vasc Endovasc Surg. 2010;40(4):461-7. doi: 10.1016/j.ejvs.2010.06.014.
- Mistraletti G, Umbrello M, Sabbatini G, Miori S, Taverna M, Cerri B, et al. Melatonin reduces the need for sedation in ICU patients: a randomized controlled trial. Minerva Anestesiol. 2015;81(12):1298-310.
- de Jonghe A, van Munster BC, Goslings JC, Kloen P, van Rees C, Wolvius R, et al. Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. CMAJ. 2014;186(14):E547-56. doi: 10.1503/cmaj.140495.
- do Carmo de Oliveira Ribeiro M, Simone JC, Ramiro TH, Santos VS, da Silva Nunes M, Barreto-Alves JA JA. Pain in patients undergoing appendectomy. Rev Dor. 2014;15(3):198- 201. doi: 10.5935/1806-0013.20140043.
- Javaherforooshzadeh F, Amirpour I, Janatmakan F, Soltanzadeh M. Comparison of effects of melatonin and gabapentin on post operative anxiety and pain in lumbar spine surgery: a randomized clinical trial. Anesth Pain Med. 2018;8(3):e68763. doi: 10.5812/aapm.68763.
- Hassanzadeh Kiabi H, Emadi SA, Ebadi Jamkhaneh A, Aezzi G, Shahzadeh Ahmadi N. Effects of preoperative melatonin on postoperative pain following cesarean section: a randomized clinical trial. Ann Med Surg (Lond). 2021;66:102345. doi: 10.1016/j.amsu.2021.102345.
- Laflı Tunay D, Türkeün Ilgınel M, Ünlügenç H, Tunay M, Karacaer F, Biricik E. Comparison of the effects of preoperative melatonin or vitamin C administration on postoperative analgesia. Bosn J Basic Med Sci. 2020;20(1):117-24. doi: 10.17305/bjbms.2019.4379.
- Haddadi S, Shahrokhirad R, Ansar MM, Marzban S, Akbari M, Parvizi A. Efficacy of preoperative administration of acetaminophen and melatonin on retrobulbar block associated pain in cataract surgery. Anesth Pain Med. 2018;8(5):e61041. doi: 10.5812/aapm.61041.
- Andersen LP, Werner MU, Rosenberg J, Gögenur I. A systematic review of peri-operative melatonin. Anaesthesia. 2014;69(10):1163-71. doi: 10.1111/anae.12717.
- Zhu C, Xu Y, Duan Y, Li W, Zhang L, Huang Y, et al. Exogenous melatonin in the treatment of pain: a systematic review and meta-analysis. Oncotarget. 2017;8(59):100582-92. doi: 10.18632/oncotarget.21504.
- Oh SN, Myung SK, Jho HJ. Analgesic efficacy of melatonin: a meta-analysis of randomized, double-blind, placebo-controlled trials. J Clin Med. 2020;9(5):1553. doi: 10.3390/ jcm9051553.