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Melatonin Pagkatapos ng Operasyon sa Balikat

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Bakit kami nagrereseta ng melatonin pagkatapos ng operasyon sa balikat, kung ano ang ipinapakita ng ebidensya mula sa trial, ang dosis na ginagamit namin, at kung ano ang dapat asahan mula rito.

Illustration: Melatonin Pagkatapos ng Operasyon sa Balikat

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Kung sumailalim ka na sa operasyon sa balikat sa amin, o nakatakdang sumailalim, maaaring binigyan ka ng reseta para sa melatonin kasabay ng iyong mga painkiller. Ipinapaliwanag ng pahinang ito kung bakit namin ito nirereseta, kung ano ang ginagawa at hindi nito ginagawa, at kung paano ito inumin.

Bakit ka binigyan ng melatonin

Ang pagtulog ay isa sa pinakamahirap na bahagi ng unang ilang linggo pagkatapos ng operasyon sa balikat. Mas sumasakit ang balikat kapag nakahiga, hindi ka makakuha ng iyong nakasanayang posisyon, at nagiging awkward ang pag-aayos ng posisyon dahil sa sling. Ang putol-putol na pagtulog ay nagiging sanhi upang mas lumala ang pakiramdam ng sakit sa susunod na araw. Ang aming pahina tungkol sa sleep, pain and recovery ay tumatalakay sa praktikal na bahagi nito: pagpoposisyon, tamang oras ng pag-inom ng mga painkiller, at mga gawi sa pagtulog.

Karaniwan na kaming nagrereseta ng melatonin pagkatapos ng operasyon sa balikat dahil isang high-quality trial sa keyhole rotator cuff repair ang nakatuklas na pinabuti nito ang pagtulog sa mga unang linggo, at ang mga pasyenteng uminom nito ay nag-ulat ng mas mabuting function ng balikat at gumamit ng mas kaunting malalakas na painkiller sa mga sumunod na buwan. Ang melatonin ay banayad, hindi ito nakaka-depende (not habit-forming), at hindi ito nakikipag-interact sa mga gamot sa sakit gaya ng ginagawa ng mga conventional na sleeping tablets. Para sa isang pansamantalang problema na may inaasahang katapusan, ito ay isang mabuting trade-off.

Ano ang melatonin

Ang melatonin ay isang hormone na ginagawa ng iyong sariling katawan sa gabi, na inilalabas ng isang maliit na glandula sa utak kapag dumidilim na. Ito ang signal na nagsasabi sa nalalabing bahagi ng katawan na gabi na. Ang tablet ay isang synthetic na kopya ng hormone na iyon.

Hindi ito isang sedative. Ang sleeping tablet ay pinipilit ang iyong pagtulog; ang melatonin ay itinutulak ang body clock at ginagawang mas madali ang pagtulog, at ang pananatiling tulog. Ito ang dahilan kung bakit ito karaniwang iniinom nang isang oras o higit pa bago matulog sa halip na sa sandaling gusto mo nang makatulog, at kung bakit ito pinaka-epektibo bilang bahagi ng isang regular na bedtime routine.

Ano ang ipinapakita ng ebidensya

Ang pagsubok sa balikat. Noong 2024, ang Rothman Orthopaedic Institute sa Philadelphia ay naglathala ng isang randomised trial ng 80 pasyenteng sumailalim sa keyhole rotator cuff repair. Ang kalahati ay uminom ng 5 mg ng melatonin isang oras bago matulog gabi-gabi sa loob ng anim na linggo, simula sa araw ng operasyon; ang kabilang kalahati ay sumunod sa standard sleep-hygiene advice. Ang mga uminom ng melatonin ay may nasusukat na mas mabuting pagtulog sa ika-anim na linggo, mas mataas ang ibinigay na rating sa kalidad ng kanilang pagtulog hanggang sa ika-anim na buwan, mas mataas ang nakuhang marka sa isang standard shoulder-function questionnaire sa ika-apat at ika-anim na buwan, at gumagamit ng mas kaunting opioid painkillers sa ika-apat na buwan. Walang iniulat na side effects sa alinmang grupo.

Ito ay isang pagsubok lamang, mula sa isang sentro, at alam ng mga pasyente kung sa aling grupo sila kabilang, kaya ang resulta ay dapat basahin bilang nakaka-encourage sa halip na definitive. Gayunpaman, ito ang pinakamahusay na ebidensyang available para sa eksaktong sitwasyong kinalalagyan mo.

Iba pang mga operasyon. Ang melatonin ay sinubukan pagkatapos ng maraming uri ng operasyon. Sa pagsasama-sama ng sampung pagsubok at 725 pasyente, nagdulot ito ng maliit na pagbuti sa kalidad ng pagtulog pagkatapos ng operasyon sa pangkalahatan. Pagkatapos ng hip and knee replacement, ilang placebo-controlled trials ang nakakita ng kakaunti o walang benepisyo lampas sa unang ilang gabi. Kaya ang melatonin ay hindi isang universal fix, at hindi namin sinasabing ito ay ganoon. Ang resulta sa balikat ang pinaka-convincing, kaya ito ang dahilan kung bakit namin ito ginagamit doon.

Bumabuti ang pagtulog kahit wala nito. Nakatutulong na malaman ang natural na takbo. Pagkatapos ng rotator cuff repair, ang pagtulog ay karaniwang nasa pinakamalalang kalagayan sa paligid ng ikalawang linggo, malinaw na mas mabuti na sa ika-anim na linggo hanggang tatlong buwan, at bumabalik sa normal para sa karamihan ng mga tao sa ika-anim na buwan, at nananatili itong ganoon pagkalipas ng mga taon. Ang melatonin ay nariyan upang gawing mas madali ang mga unang linggong iyon. Hindi ito isang long-term treatment at hindi mo na ito kakailanganin kapag kumalma na ang balikat.

Paano namin ito nirereseta

  • Dose: 2 mg hanggang 5 mg, depende sa iyong sitwasyon; nakasaad sa iyong reseta kung alin dito.
  • Kailan: mga isang oras bago ang iyong nakagawiang oras ng pagtulog, sa halos parehong oras gabi-gabi.
  • Gaano katagal: mula sa gabi ng operasyon, o sa iyong unang gabi sa bahay, sa loob ng humigit-kumulang anim na linggo, na siyang period na sinaklaw ng trial. Pagkatapos ay itigil na lamang; hindi na kailangang dahan-dahang bawasan ang dose (taper off).
  • Bakit kailangan ng reseta: sa Australia, ang melatonin ay isang prescription medicine para sa karamihan ng mga adult. Ang tanging over-the-counter na anyo, isang 2 mg slow-release tablet mula sa pharmacist, ay aprubado para sa mga taong may edad 55 pataas na may insomnia. Dahil magkaiba ang dose at dahilan pagkatapos ng operasyon, gumagawa kami ng reseta upang makuha mo ang tamang anyo nito.

Inumin ito kasabay, at hindi kapalit, ng iba pang mga bagay na nakatutulong: pagtulog nang naka-prop up sa unang dalawang linggo, pagsuot ng iyong sling sa gabi ayon sa itinuro, pag-inom ng iyong regular na painkillers ayon sa iskedyul upang gumana ang mga ito bago ka humiga, at pag-ice sa gabi.

Mga side effect at mga babala

Ang Melatonin ay tinatanggap nang maayos ng karamihan sa mga tao. Ang mga pinakakaraniwang reklamo ay ang pakiramdam na medyo lula sa umaga, matingkad na panaginip, sakit ng ulo o bahagyang pagduduwal. Ang pagkalula sa umaga ay karaniwang nawawala sa pamamagitan ng pag-inom ng tablet nang mas maaga nang kaunti sa gabi o pagbaba sa mas mababang dose. Hindi ito nakaka-adik at walang withdrawal kapag itinigil ito.

Hindi ka naman magmamaneho sa mga unang linggo pagkatapos ng operasyon sa balikat; kapag pinayagan ka nang magmaneho, maging aware sa pagkaantok sa umaga sa unang ilang araw na pagbabalik sa pagmamaneho. Iwasan ang alak sa mga gabing iniinom ito.

Sabihan kami kung alinman sa mga ito ang naaangkop, upang maiaadjust namin ang plano:

  • umiinom ka ng warfarin o iba pang blood thinner, dahil ang melatonin ay maaaring makaapekto sa mga clotting test
  • mayroon kang epilepsy o isang autoimmune condition
  • ikaw ay buntis o nagpapasuso
  • umiinom ka na ng sleeping tablet o isang antidepressant

Ano ang dapat asahan

Huwag asahan na makakatulog agad nang mahimbing sa unang gabi. Ang benepisyo sa pagsubok ay lumabas sa loob ng ilang linggo, habang unti-unting nagiging regular ang pagtulog, sa halip na isang biglaang pagbabago sa unang gabi. Kung sakit ang gumigising sa iyo, ang solusyon ay pain control at positioning muna; hindi mapagtatakpan ng melatonin ang isang balikat na hindi komportable.

Kung tila hindi ito nakakatulong sa iyo, o mas gusto mong huwag itong inumin, ayos lang iyon. Ito ay isang opsyon sa iyong recovery, hindi isang mahalagang bahagi. Sabihin sa amin sa iyong review at aalisin namin ito sa iyong listahan.

Ang pinaka-importante

Karaniwan, pansamantala, at nararapat gamutin ang kawalan ng maayos na tulog pagkatapos ng operasyon sa balikat. Isang magandang pag-aaral ang nakatuklas na ang anim na linggong paggamit ng melatonin ay nagpapadali sa mga unang linggo at maaaring magresulta sa mas mabuting function sa huli; ang gamot ay banayad at hindi nakaka-addict. Iyan ang dahilan kung bakit ito ay nasa iyong reseta.

Kailan dapat tumawag sa amin

  • Pananakit na lumalala sa halip na bumubuti, o hindi nakokontrol ng iyong mga gamot
  • Pagkaantok sa araw o pagkalito na higit pa sa banayad
  • Pangangati (rash), pamamaga ng mukha o mga labi, o hirap sa paghinga pagkatapos ng isang dose: itigil ang mga tabletas at pumunta sa emergency department
  • Ang mga karaniwang babala sa sugat at pangkalahatang babala na nakalista sa pahinang sleep, pain and recovery

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