The anxiolytic and analgesic effects of melatonin: a study protocol for a randomized, double-blind, placebo-controlled study

The anxiolytic and analgesic effects of melatonin

  • Bennedikte Kollerup Madsen Department of Surgery D, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
  • Dennis Zetner, MD Department of Surgery D, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
  • Lars Peter Kloster Andersen, MD Department of Anesthesia and Intensive Care Z, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark
  • Jacob Rosenberg, DMSc Department of Surgery D, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
Keywords: Melatonin, Anxiety, Pain, Perioperative

Abstract

 

Anxiety and pain are both significant clinical challenges following surgery. Melatonin has been demonstrated to have both anxiolytic and analgesic effects in numerous experimental and clinical studies. This study protocol aims to present the design of a randomized study investigating the anxiolytic and analgesic effects of exogenous melatonin in cosmetic breast augmentation.

     The study will be a randomized, double-blind, placebo-controlled trial. Included patients are candidates for primary breast augmentation or replacement of existing implants. Patients receive a standardized general anesthetic and postoperative analgesic regimen. The study medication includes 4 separate doses, containing either 10 mg of melatonin or placebo. Doses are administered orally at 21:00 hours of the night before surgery, 120 minutes before surgery, immediately after surgery in the post-anesthesia care unit, and at 21:00 hours of the night following surgery.

     The two primary outcomes are preoperative anxiety, assessed by the State-Trait Anxiety Inventory and pain, measured by an integrated assessment of longitudinally measured pain intensity and opioid consumption. Secondary outcomes are VAS anxiety, and VAS pain, sleep quality, general fatigue and wellbeing.

     This study protocol presents in detail the design of a randomized, double-blind, placebo-controlled study investigating the anxiolytic and analgesic effects of repeated doses of exogenous melatonin in patients undergoing cosmetic breast augmentation.  

 

References

1. Caumo W, Schmidt A-P, Schneider C-N, Bergmann J, Iwamoto C-W et al. (2002) Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol. Scand. 46: 1265-1271.
2. Stanley S-S, Hoppe I-C, Ciminello F-S (2012) Pain control following breast augmentation: a qualitative systematic review. Aesthet. Surg. J. 32: 964–972.
3. Rawal N, Gupta A, Helsing M, Grell K, Allvin R (2006) Pain relief following breast augmentation surgery: a comparison between incisional patient-controlled regional analgesia and traditional oral analgesia. Eur. J. Anaesthesiol. 23: 1010–1017.
4. American Society of Plastic Surgeons. Plastic Surgery Statistics Report 2017. https://www.plasticsurgery.org/documents/
News/Statistics/2017/plastic-surgery-statistics-full-report-2017.pdf. (Accessed September 26, 2018).
5. Klein M, Gögenur I, Rosenberg J (2012) Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ. 345: e6166.
6. Kehlet H (2005) Postoperative opioid sparing to hasten recovery: what are the issues? Anesthesiology. 102: 1083–1085.
7. Ashton H (1994) Guidelines for the rational use of benzodiazepines. When and what to use. Drugs. 48: 25‐40.
8. Brzezinski A (1997) Melatonin in humans. N. Engl. J. Med. 336: 186–195.
9. Srinivasan V, Pandi-Perumal S-R, Spence D-W, Moscovitch A, Trakht I et al. (2010) Potential use of melatonergic drugs in analgesia: mechanisms of action. Brain. Res. Bull. 81: 362–371.
10. Ochoa-Sanchez R, Rainer Q, Comai S, Spadoni G, Bedini A et al. (2012) Anxiolytic effects of the melatonin MT(2) receptor partial agonist UCM765: comparison with melatonin and diazepam. Prog. Neuropsychopharmacol. Biol. Psychiatry. 39: 318–325.
11. Andersen L-P, Werner M-U, Rosenberg J, Gögengur I (2014) A systematic review of peri-operative melatonin. Anaesthesia. 69: 1163–1171.
12. Moher D, Hopewell S, Schulz K-F, Montori V Gøtzsche P-C et al. (2012) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int. J. Surg. 10: 28–55.
13. Spielberger C-D, Gorsuch R-L, Lushene R, Vagg P-R, Jacobs G-A (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, California, USA.
14. Dai F, Silverman D-G, Chelly J-E, Li J, Belfer I, Qin L (2013) Integration of pain score and morphine consumption in analgesic clinical studies. J. Pain. 14: 767–777.
15. Akerstedt T, Gillberg M (1990) Subjective and objective sleepiness in the active individual. Int. J. Neurosci. 52: 29–37.
16. Christensen T, Bendix T, Kehlet H (1982) Fatigue and cardiorespiratory function following abdominal surgery. Br. J. Surg. 69: 417–419.
17. Caumo W, Schmidt A-P, Schneider C-N, Bergmann J, Iwamoto C-W et al (2001) Risk factors for postoperative anxiety in adults. Anaesthesia. 56: 720-728.
18. McCarthy C-M, Pusic A-L, Hidalgo D-A (2009) Efficacy of pocket irrigation with bupivacaine and ketorolac in breast augmentation: a randomized controlled trial. Ann. Plast. Surg. 62: 15–17.
19. Ong C-K, Lirk P, Tan J-M, Sow B-W (2005) The analgesic efficacy of intravenous versus oral tramadol for preventing postoperative pain after third molar surgery. J. Oral. Maxillofac. Surg. 63; 1162–1168.
20. Andersen LP, Gögenur I, Rosenberg J, Reiter R-J (2016) The Safety of Melatonin in Humans. Clin. Drug. Investig. 36: 169-175.
21. International Comitee of Medical Journal Editors. Defining the role of authors and contributers. http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html (Accessed December 14, 2018).
22. Yousaf F, Seet E, Venkatraghavan L, Abrishami A, Chung F (2010) Efficacy and safety of melatonin as an anxiolytic and analgesic in the perioperative period: a qualitative systematic review of randomized trials. Anesthesiology. 113: 968–976.
Published
2019-06-08
How to Cite
[1]
Kollerup Madsen, B., Zetner, D., Andersen, L.P. and Rosenberg, J. 2019. The anxiolytic and analgesic effects of melatonin: a study protocol for a randomized, double-blind, placebo-controlled study. Melatonin Research. 2, 2 (Jun. 2019), 22-34. DOI:https://doi.org/https://doi.org/10.32794/mr11250019.
Section
Research Articles