Comparison between Two Different Doses of Sublingual Melatonin to Alleviate Anxiety and Pain Associated with Elective Gynecological Surgeries under General Anesthesia; a Randomized controlled trial.

Background: Perioperative anxiety and postoperative pain are common challenges in women undergoing elective gynecological surgeries. Traditional anxiolytics carry risks such as sedation, respiratory depression, or cardiovascular effects, highlighting the need for safer alternatives. This study aimed to determine the anxiolytic effect of preoperative sublingual melatonin and its associated impact on postoperative pain scores when two different doses used in females undergoing elective gynecological surgeries. Methods: This a randomized controlled study included 96 females underwent elective gynecological surgeries. The cases were divided into three equal groups: Group M1: received 3 mg of sublingual melatonin the night and 1 hour before the surgery. Group M2 received 6 mg at the same time points; Group C received no premedication. Beck anxiety inventory (BAI) and Numerical rating Scale (NRS) were recorded as primary outcomes. Side effects related to the drug and Time of 1st rescue analgesia request were also assessed. Results: Both melatonin groups showed significantly diminished BAI scores at 2 and 12 h postoperatively in contrast with baseline and intraoperative scores (p<0.001). Postoperative NRS scores were significantly reduced in group M2 at 6 and 12 h, and in both M1 and M2 at 24 h (p<0.05). Morphine consumption and time to first rescue analgesia were significantly improved in both melatonin groups versus control. Adverse effects were minimal and dose-related. Conclusion: Sublingual melatonin is a safe and effective premedication for reducing perioperative anxiety and postoperative pain in elective gynecological surgery, with the 3 mg dose offering optimal efficacy and tolerability.