title: Melatonin premedication versus placebo in wisdom teeth extraction: a randomised controlled trial.
abstract: BACKGROUND
  Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions.
  
  
  METHODS
  This randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores.
  
  
  RESULTS
  Maximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores.
  
  
  CONCLUSIONS
  Melatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.
authors.affiliation: Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
authors.forename: Edwin
authors.initials: E
authors.lastname: Seet
authors.affiliation: Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
authors.forename: Chen Mei
authors.initials: CM
authors.lastname: Liaw
authors.affiliation: Department of Dental Surgery, Khoo Teck Puat Hospital, Singapore.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Tay
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
authors.forename: Chang
authors.initials: C
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000627:therapeutic use*; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011229:Preanesthetic Medication / Q000379:methods*; D057234:Preoperative Period; D011446:Prospective Studies; D012737:Sex Factors; D013515:Surgery, Oral / Q000379:methods*; D014081:Tooth Extraction; D055815:Young Adult
chemical_list: D008550:Melatonin
keywords: anxiety; melatonin; pain; wisdom teeth extraction