Perioperative Use of Melatonin in Joint Arthroplasty: A Critical Systematic Review of Randomized Clinical Studies

Joint arthroplasty for shoulder, hip and knee joints is a widely performed surgical intervention in orthopedics practice. Early postoperative complications include pain, delirium and cognitive dysfunction, urinary retention, sleep disturbance, anxiety and others. Melatonin is a sleep-inducing hormone successfully tried for management of many painful conditions, postoperative sleep disturbance, and postoperative delirium. This systematic review aimed to critically analyze the randomized clinical studies on the therapeutic effects of perioperative melatonin administration in patients submitted to joint arthroplasty. It was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eight articles were progressed to final analysis. The effect of melatonin administration on postoperative pain and sleep quality was assessed by six studies while its effect on delirium was assessed by two studies. In conclusion, the present review found variable degrees of success of melatonin administration for management of postoperative pain, sleep disturbance and delirium. However, based on published studies, use of melatonin for management of these conditions lacks robust clinical evidence.