Efficacy and Safety of Preoperative Melatonin for Women Undergoing Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Author:

Albzea Wardah1,Almonayea Lolwa2,Aljassar Marah2,Atmeh Mousa3,Al Sadder Khaled4,AlQattan Yousef2,Alhajaji Raghad5,AlNadwi Hiba6,Alnami Inaam7,Alhajaji Fatima8

Affiliation:

1. Faculty of Medicine, Alexandria University, Alexandria 21544, Egypt

2. Kuwait Institute for Medical Specializations, Kuwait City 12050, Kuwait

3. Department of Hemto-Oncology, Royal Medical Services, Amman 11855, Jordan

4. Department of General Surgery, Ministry of Health, Kuwait City 12009, Kuwait

5. Department of Family Medicine, Almagrah Primary Health Care, Ministry of Health, Makkah 11176, Saudi Arabia

6. King Abdullah Medical City, Makkah 57657, Saudi Arabia

7. Senior Registerar Family Medicine, Internal Medicine Department, Security Forces Hospital Program, Makkah 14799, Saudi Arabia

8. College of Medicine, Umm Alqura University, Makkah 57483, Saudi Arabia

Abstract

Background: Cesarean section (CS) has been linked to a number of negative effects, such as pain, anxiety, and sleeping problems. The aim of this systematic review and meta-analysis was to investigate the safety and efficacy of preoperative melatonin on postoperative outcomes in pregnant women who were scheduled for elective CS. Methods: We systemically searched 4 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) from inception until 10 March 2023. We included randomized controlled trials (RCTs) comparing melatonin and placebo for postoperative outcomes in CS patients. For risk of bias assessment, we used the Cochrane Risk of Bias 2 tool. Continuous variables were pooled as mean difference (MD), and categorical variables were pooled as a risk ratio (RR) with a 95% confidence interval (CI). Results: We included 7 studies with a total of 754 pregnant women scheduled for CS. The melatonin group had a lower pain score (MD = −1.23, 95% CI [−1.94, −0.51], p < 0.001) and longer time to first analgesic request (MD = 60.41 min, 95% CI [45.47, 75.36], p < 0.001) than the placebo group. No difference was found regarding hemoglobin levels, heart rate, mean arterial pressure, total blood loss, or adverse events. Conclusions: Preoperative melatonin may reduce postoperative pain in CS patients without side effects. This research offers a safe and affordable pain management method for this population, which has clinical consequences. Further research is needed to validate these findings and determine the best melatonin dosage and timing.

Publisher

MDPI AG

Subject

General Medicine

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3. Prevalence, indications and neonatal complications of caesarean deliveries in Cameroon: A systematic review and meta-analysis;Njim;Arch. Public Health,2020

4. Human Reproductive Health (2023, March 29). Caesarean Section Rates Continue to Rise, Amid Growing Inequalities in Access. WHO. Available online: https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access.

5. Indications for and Risks of Elective Cesarean Section;Mylonas;Dtsch. Arztebl. Int.,2015

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