Impact of Melatonin as a Premedication Agent in Caesarean Section on Blood Loss and Postoperative Pain Level

Abstract

Background. Postpartum hemorrhage (PPH) is a serious postdelivery condition with a high incidence of morbidity and mortality for women who undergo childbirth with or without a caesarean section. Melatonin has been suggested to increase the contractility of myometrium and reduce the pain score postoperatively, therefore it is believed that the use of melatonin before surgery may decrease blood loss, reduce pain score, and decrease the need for postoperative opioids. Objectives. The main objectives of this study are focused on the investigation of melatonin as a premedication agent to reduce blood loss and decrease pain score postoperatively in patients undergoing cesarean section under spinal anesthesia. Methods. 80 patients were scheduled for spinal anesthesia-based cesarean sections and randomly assigned to two groups, melatonin group (M) 40 patients and placebo group (P) 40 patients to receive either 10 mg of sublingual melatonin or a placebo of 90 minutes preoperatively. Hemoglobin levels were been measured preoperative and 12 hrs. Postoperatively, blood loss volume was calculated by measuring both the weight of used materials before and after the surgery and the volume sucked in the suction bottle after placental delivery. Postoperative visual pain score and analgesic requirements were used to evaluate pain levels. Results. Analyzed collected data showed a significant decrease in blood loss in the melatonin group in comparison with the placebo group as measured by the hemoglobin level. On the other hand, there is a significant decrease in pain score and analgesia requirement with the melatonin group compared to the placebo group. Conclusion. Melatonin is a promising premedication drug that has a significant impact on postpartum hemorrhage by reducing blood loss and pain levels of mothers who have undergone C-sections.

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

“…Additionally, this dose of sublingual melatonin proved effective in enhancing analgesia and reducing the incidence of spinal-related issues in patients undergoing cesarean section under spinal anesthesia. 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][12][13]. The results of studies by Khare et al [14] and Lotfy and Ayaad [15] align with that of the current study.…”

“…Additionally, the autonomic response triggered by the surgical setting can exacerbate this anxiety. Uterine blood flow can get compressed by these stress responses leading to fetal distress [2,3]. Apart from anxiety, spinal anesthesia commonly triggers autonomic sympathetic blockade, causing a decrease in systemic vascular resistance and subsequent hypotension.…”

“…However, it's worth noting that both midazolam and mirtazapine may be associated with some unfavorable side effects like an increase in the incidence of postoperative nausea and vomiting (PONV) [2,8,9]. Some previous and recent studies have suggested that the use of melatonin before cesarean surgery, has a role in reducing the oxidative stress in septicemic newborns, enhancing the baby outcomes, and reducing the possibility of oxidative stress incidence or damaging of blood supply of asphyxiated newborns [3,9,10].…”