Evaluating the utility of melatonin in spine surgery: a systematic review and meta-analysis of randomized clinical trials.
Shahabeddin Yazdanpanah, Hana-Joy E Hanks, Sultan Baz et al.
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In 30 seconds
This preregistered systematic review and meta-analysis assessed melatonin after spine surgery, drawing on six moderate-quality randomized trials identified from 749 screened studies. The trials included 227 patients given melatonin (3–10 mg), with procedures mainly uncomplicated lumbar laminectomies and outcomes assessed through 24 hours. Across most studies reporting the outcomes, melatonin improved early postoperative pain, blood-pressure-related, analgesic-related, and anxiety-related measures versus placebo. Benefits over active drug comparators were less consistent; a limited meta-analysis found higher 24-hour VAS-pain with melatonin than gabapentin, but the mean difference was near-negligible.
Key findings
- Six moderate-quality randomized trials included 227 melatonin-treated patients; doses ranged from 3–10 mg.
- Melatonin improved early postoperative pain, blood-pressure-related, analgesic-related, and anxiety-related outcomes versus placebo across most studies reporting them.
- Against active pharmacologic comparators, significant benefits appeared only in select nausea- and anxiety-related outcomes.
- A two-study meta-analysis found higher 24-hour VAS-pain with melatonin than gabapentin, with a near-negligible mean difference and substantial statistical constraints.
Why it matters
Postoperative pain and anxiety remain common after spine surgery, and these trials suggest melatonin may offer benefits compared with placebo. However, the evidence does not show consistent superiority to active pharmacologic options. Distinguishing placebo comparisons from active-treatment comparisons is important when interpreting melatonin’s potential role in postoperative symptom management.
What to keep in mind
Evidence came from six moderate-quality trials, with procedures mainly uncomplicated lumbar laminectomies and outcomes assessed only up to 24 hours. The meta-analysis was limited to two studies and had substantial statistical constraints.