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Melatonina após cirurgia no ombro

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Por que prescrevemos melatonina após cirurgia no ombro, quais são as evidências dos ensaios clínicos, a dose que utilizamos e o que se pode esperar dela.

Illustration: Melatonina após cirurgia no ombro

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Caso tenha sido submetido a uma cirurgia no ombro conosco, ou esteja prestes a passar por uma, é possível que tenha recebido uma receita para melatonina juntamente com os analgésicos. Esta página explica por que a prescrevemos, o que ela faz e o que não faz, além de como deve ser tomada.

Por que você recebeu melatonina

O sono é um dos maiores desafios nas primeiras semanas após a cirurgia no ombro. O ombro dói mais quando se está deitado; não é possível assumir a posição habitual, e a tipóia dificulta ainda mais o adormecimento. O sono interrompido, por sua vez, faz com que a dor pareça pior no dia seguinte. Nossa página sobre sono, dor e recuperação aborda os aspectos práticos disso: posicionamento, horário para tomar analgésicos e hábitos de sono.

Atualmente, prescrevemos rotineiramente melatonina após a cirurgia no ombro, pois um estudo de boa qualidade realizado em casos de reparo artroscópico do manguito rotador constatou que ela melhora o sono nas primeiras semanas; além disso, os pacientes que a tomaram relataram melhor função do ombro e utilizaram menos analgésicos potentes nos meses seguintes. A melatonina é suave, não gera dependência e não interage com os medicamentos para dor da mesma forma que os comprimidos para dormir convencionais. Para um problema temporário com duração previsível, esse é um bom equilíbrio entre benefícios e riscos.

O que é a melatonina

A melatonina é um hormônio produzido pelo próprio corpo durante a noite, liberado por uma pequena glândula no cérebro quando escurece. Ele serve como sinal para o restante do corpo, indicando que é noite. O comprimido é uma cópia sintética desse hormônio.

A melatonina não é um sedativo. Os comprimidos para dormir forçam o sono; a melatonina, por sua vez, ajuda a regular o relógio biológico, facilitando tanto o início quanto a manutenção do sono. Por isso, costuma ser tomada cerca de uma hora antes de deitar, e não no exato momento em que se deseja dormir. Além disso, funciona melhor quando integrada a uma rotina regular de sono.

O que as evidências mostram

O estudo sobre o ombro. Em 2024, o Rothman Orthopaedic Institute, na Filadélfia, publicou um estudo randomizado com 80 pacientes submetidos à reparação artroscópica do manguito rotador. Metade tomou 5 mg de melatonina uma hora antes de dormir, todas as noites, durante seis semanas, começando no dia da cirurgia; a outra metade seguiu as orientações padrão de higiene do sono. Os pacientes que tomaram melatonina apresentaram melhoria mensurável no sono após seis semanas; avaliaram a qualidade do sono como superior até os seis meses; obtiveram pontuações mais altas num questionário padrão de função do ombro aos quatro e seis meses; e utilizaram menos analgésicos opioides aos quatro meses. Não foram relatados efeitos colaterais em nenhum dos grupos.

Trata-se de apenas um estudo, realizado num único centro, e os pacientes sabiam em qual grupo estavam; portanto, os resultados devem ser considerados encorajadores, mas não definitivos. Ainda assim, são as melhores evidências disponíveis para a situação exata em que você se encontra.

Outras cirurgias. A melatonina foi testada após diversos tipos de cirurgia. A análise conjunta de dez estudos envolvendo 725 pacientes indicou uma pequena melhora na qualidade do sono pós-operatório. Após artroplastia de quadril e joelho, vários estudos controlados com placebo mostraram pouco ou nenhum benefício além das primeiras noites. Portanto, a melatonina não é uma solução universal; nós tampouco afirmamos isso. O resultado referente ao ombro é o mais convincente, motivo pelo qual a utilizamos nesse caso.

O sono melhora naturalmente. É útil conhecer a evolução natural do processo. Após a reparação do manguito rotador, o sono costuma ser pior por volta da segunda semana; já aos seis semanas e três meses ele melhora consideravelmente, e, para a maioria das pessoas, volta ao normal aos seis meses, permanecendo assim por anos. A melatonina serve para facilitar esse período inicial. Não se trata de um tratamento de longo prazo; você não precisará dela assim que o ombro se estabilizar.

Como o prescrevemos

  • Dose: 2 mg a 5 mg, dependendo das suas circunstâncias; a receita indicará qual dose usar.
  • Quando: aproximadamente uma hora antes da sua hora habitual de dormir, sempre à mesma hora todas as noites.
  • Por quanto tempo: a partir da noite da cirurgia, ou da primeira noite em casa, por cerca de seis semanas – período abrangido pelo estudo clínico. Depois, basta interromper o uso; não há necessidade de reduzir a dose gradualmente.
  • Por que é necessária uma receita: na Austrália, a melatonina é um medicamento de prescrição para a maioria dos adultos. A única forma vendida sem receita, um comprimido de liberação lenta de 2 mg obtido no farmacêutico, é aprovada apenas para pessoas com 55 anos ou mais que sofrem de insônia. Como a dose e o motivo de uso são diferentes após a cirurgia, emitimos uma receita para que você receba a forma correta do medicamento.

Tome a melatonina juntamente com, mas não em substituição, às demais medidas que ajudam: manter a cabeça elevada durante as primeiras semanas, usar a tipoia à noite conforme orientado, tomar os analgésicos regularmente para que façam efeito antes de deitar-se, e aplicar gelo à noite.

Efeitos colaterais e precauções

A melatonina é bem tolerada pela maioria das pessoas. As queixas mais comuns são sensação de sonolência pela manhã, sonhos vívidos, dor de cabeça ou náusea leve. A sonolência matinal geralmente desaparece se o comprimido for tomado um pouco mais cedo à noite ou se a dose for reduzida. Não gera dependência, e não há sintomas de abstinência ao interromper o uso.

De qualquer forma, você não poderá dirigir nas primeiras semanas após a cirurgia no ombro; quando receber autorização para dirigir, fique atento à sonolência matinal nos primeiros dias ao volante. Evite álcool nas noites em que tomar melatonina.

Informe-nos se alguma das seguintes situações se aplica, para que possamos ajustar o plano:

  • você toma varfarina ou outro anticoagulante, pois a melatonina pode afetar os exames de coagulação
  • você tem epilepsia ou alguma doença autoimune
  • você está grávida ou amamentando
  • você já toma comprimidos para dormir ou antidepressivos

O que esperar

Não espere adormecer profundamente na primeira noite. Os benefícios observados no estudo só se tornaram evidentes após algumas semanas, à medida que o sono foi se tornando mais estável, e não como uma mudança drástica já na primeira noite. Se é a dor que o acorda, o correto é controlar a dor e ajustar a posição do corpo; a melatonina não conseguirá compensar um ombro que não esteja confortável.

Se o medicamento não parecer ajudar ou se você preferir não tomá-lo, tudo bem. Ele é um componente opcional do seu processo de recuperação, não essencial. Informe-nos na sua consulta de acompanhamento e o retiraremos da sua lista de tratamentos.

Resumo

A má qualidade do sono após cirurgia no ombro é comum, temporária e merece tratamento. Um bom estudo demonstrou que seis semanas de uso de melatonina facilitam as primeiras semanas pós-operatórias e podem trazer benefícios funcionais posteriormente; o medicamento é suave e não causa dependência. Por isso ele consta na sua prescrição.

Quando nos contactar

  • Dor que está a piorar em vez de melhorar, ou que os seus medicamentos não conseguem controlar
  • Sonolência diurna ou confusão mental que vão além do leve
  • Erupção cutânea, inchaço no rosto ou nos lábios, ou dificuldade em respirar após a toma do medicamento: pare de tomar os comprimidos e dirija-se ao serviço de urgências
  • Os sinais habituais de complicações na ferida e outros avisos gerais listados na página sono, dor e recuperação

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