Preoperative melatonin and zolpidem reduce postoperative pain and opioid use

A review published in the Journal of Pain & Palliative Care Pharmacotherapy analyzed the effects of preoperative melatonin and zolpidem on postoperative pain and opioid consumption. The review included 16 studies involving over 1,100 surgical patients, focusing on various procedures from dental to abdominal surgeries. The findings suggest that addressing sleep disturbances and anxiety before surgery may improve recovery outcomes.

Melatonin's Effects

Melatonin, a hormone that regulates sleep, showed anxiolytic, analgesic, and chronobiotic effects in the studies reviewed. It was found to reduce salivary cortisol levels, modulate stress responses, and support circadian recovery, particularly in patients with preoperative anxiety. In some trials, its analgesic efficacy was comparable to clonidine, and it demonstrated a favorable safety profile.

Zolpidem's Role

Zolpidem, a prescription sleep medication, improved preoperative sleep quality and was associated with reduced postoperative pain and opioid consumption. In colorectal surgery, patients receiving zolpidem experienced lower levels of tumor necrosis factor-alpha (TNF-α). The review indicates that while melatonin may offer broader neuroendocrine and analgesic benefits, zolpidem may be particularly beneficial for patients suffering from insomnia. The authors recommend larger trials to optimize dosing and patient selection for these medications.