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Melatonin After Shoulder Surgery

Why we prescribe melatonin after shoulder surgery, what the trial evidence shows, the dose we use, and what to expect from it.

22 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Sleep disturbances are commonly observed before and after arthroscopic surgery of the shoulder [8]. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin [1]. However, the effect of melatonin on postoperative adverse events was comparable between melatonin and control groups [3].

In contrast, melatonin does not appear to have a significant impact on postoperative sleep following total joint arthroplasty [2]. Global PSQI scores were higher at 2 and 6 weeks postoperatively compared with baseline in both melatonin and placebo groups, with no significant differences noted between the groups at either time point after primary total joint arthroplasty [7]. Results do not support the routine use of melatonin after total knee arthroplasty [9].

Melatonin, corticosteroids, and anticonvulsants provide inconsistent benefits for enhancing postoperative recovery in primary total joint arthroplasty patients [4]. The use of melatonin for management of conditions in joint arthroplasty lacks robust clinical evidence based on published studies [6]. Melatonin and rofecoxib may provide a benefit to sleep quality in some patients undergoing total hip or knee arthroplasty, but physicians need to understand the adverse effects and contraindications before recommending these interventions [11]. Melatonin may be considered as a potential adjunct rather than a primary treatment for musculoskeletal pain management, pending randomized controlled trials with standardized dosing and longer follow-ups [5].

How It Works

Sleep Disturbance Patterns: Sleep quality generally improves after shoulder surgery, though the rate of recovery varies by surgical intervention [15]. Patients with shoulder pathologies exhibit poor sleep quality that improves postoperatively [16]. Specifically, sleep disturbance is common after rotator cuff repair, with quality worsening at 2 weeks and improving beyond baseline by 6 weeks [20]. Melatonin may benefit patients with significant sleep disturbances associated with rotator cuff repairs [1].

Efficacy in Joint Arthroplasty: Melatonin provides inconsistent benefits for enhancing postoperative recovery in primary total joint arthroplasty patients [4]. Disturbances in sleep are expected for most patients following primary total knee arthroplasty, although melatonin may have an attenuating effect [10]. However, exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree after total knee arthroplasty under regional anesthesia with sedation [17]. Similarly, melatonin may not improve overall postoperative sleep quality following total hip arthroplasty as measured by the Epworth Sleepiness Scale (ESS) [14].

Analgesic and Biomarker Effects: Melatonin administration reduced the proportion of patients with analgesic requirements and brain-derived neurotrophic factor (BDNF) levels [13]. The effect of melatonin on postoperative adverse events is comparable between melatonin and control groups [3].

Clinical Positioning: Melatonin may be considered as a potential adjunct rather than a primary treatment for musculoskeletal pain management [5]. High-quality randomized controlled trials of adequate power and methodology on the effects of pharmacological interventions on postoperative sleep are warranted [12].

What the Evidence Shows

Adverse Events and Safety: The effect on postoperative adverse events was comparable between the melatonin and control groups [3]. In the setting of a regional and multimodal analgesia recovery plan for shoulder arthroplasty patients undergoing inpatient observation, the use of an interventional sleep pathway appears to be safe and beneficial, with improved analgesia, reduced opioid use, increased sleep duration, and improved reported sleep quality during the postoperative recovery period [18].

Sleep Quality Outcomes: Melatonin treatment can improve postoperative sleep quality [19]. Global PSQI scores were higher at 2 and 6 weeks postoperatively compared with baseline in both groups, with no significant differences noted between melatonin and placebo groups at either time point after primary total joint arthroplasty [7]. Compared to placebo, melatonin did not significantly affect baseline, follow-up, or change in sleep quality (PSQI), pain (VAS), and quality of life (SF-36) scores in orthopaedic trauma patients [21].

Pain and Analgesic Requirements: Melatonin administration reduced the proportion of patients with analgesic requirements and brain-derived neurotrophic factor (BDNF) levels in the treatment of pain [13]. Given the low quality of evidence, minor degree of VAS score reduction, and inconclusive trial sequential analysis of postoperative opioid consumption, the meta-analysis neither supports nor opposes the effect of melatonin on postoperative pain [22].

Evidence Quality and Limitations: Use of melatonin for management of conditions in joint arthroplasty lacks robust clinical evidence based on published studies [6]. High-quality RCTs of adequate power and methodology on the effects of pharmacology interventions on postoperative sleep are warranted [12].

Practical Considerations

Adjunctive Role: Melatonin may be considered as a potential adjunct for the management of musculoskeletal pain, pending randomized controlled trials with standardized dosing and longer follow-ups [5].

Sleep Quality Outcomes: In patients undergoing primary total joint arthroplasty, global PSQI scores were higher at 2 and 6 weeks postoperatively compared with baseline in both melatonin and placebo groups, with no significant differences noted between the two groups at either time point [7].

Clinical Recommendation: Melatonin may provide a benefit to sleep quality in some patients undergoing total hip or knee arthroplasty, but physicians need to understand the adverse effects and contraindications before recommending this intervention [11].

Key Evidence

  • [L1] Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin. [1] (10.1177/03635465241272076)
  • [L1] Melatonin does not appear to have a significant impact on postoperative sleep following total joint arthroplasty. [2] (10.7759/cureus.107734)
  • [L1] The effect on postoperative adverse events was comparable between the melatonin and control groups. [3] (10.1007/s12630-023-02442-1)
  • [L1] Melatonin, corticosteroids, and anticonvulsants provide inconsistent benefits, underscoring the need for more rigorous, standardized, and longer-term studies to establish optimal pharmacological strategies for enhancing postoperative recovery. [4] (10.1016/j.arth.2025.08.071)
  • [L1] Melatonin may be considered as a potential adjunct rather than a primary treatment, pending randomized controlled trials with standardised dosing and longer follow-ups. [5] (10.1097/j.pain.0000000000004045)
  • [L2] However, based on published studies, use of melatonin for management of these conditions lacks robust clinical evidence. [6] (10.1080/15360288.2025.2490654)
  • [L1] Global PSQI scores were higher at 2 and 6 weeks postoperatively compared with baseline in both groups, with no significant differences noted between melatonin and placebo groups at either time point. [7] (10.5435/jaaos-d-21-00243)
  • [L1] Sleep disturbances are commonly observed before and after arthroscopic surgery of the shoulder. [8] (10.1016/j.asmr.2024.100883)
  • [L1] Our results do not support the routine use of melatonin after TKA. [9] (10.1016/j.arth.2024.01.018)
  • [L1] Disturbances in sleep should be expected for most patients, although melatonin may have an attenuating effect. [10] (10.1016/j.arth.2024.02.031)
  • [L3] Melatonin and rofecoxib may provide a benefit to sleep quality in some patients, but physicians need to understand the adverse effects and contraindications before recommending these interventions. [11] (10.1097/corr.0000000000003196)
  • [L1] High-quality RCTs of adequate power and methodology on the effects of pharmacology interventions on postoperative sleep are warranted. [12] (10.4103/joacp.joacp_428_23)
  • [L1] Moreover, melatonin administration also reduced the proportion of patients with analgesic requirements and brain-derived neurotrophic factor (BDNF) levels. [13] (10.18632/oncotarget.21504)
  • [L1] Melatonin may not improve overall postoperative sleep quality following THA as measured by the ESS. [14] (10.1016/j.arth.2025.05.038)
  • [L3] Sleep quality improves after shoulder surgery, although the rate of recovery varies by surgical intervention. [15] (10.1016/j.jseint.2025.05.034)
  • [L2] Patients with shoulder pathologies have poor sleep quality that improves after shoulder surgery. [16] (10.1177/17585732231220342)
  • [L2] Sleep quality is impaired after total knee arthroplasty and exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree. [17] (10.1016/j.arth.2015.06.034)
  • [L1] In the setting of a regional and multimodal analgesia recovery plan for shoulder arthroplasty patients undergoing inpatient observation, the use of an interventional sleep pathway appears to be safe and beneficial, with improved analgesia, reduced opioid use, increased sleep duration, and improved reported sleep quality during the postoperative recovery period. [18] (10.1016/j.jse.2022.02.035)
  • [L1] Melatonin treatment can improve postoperative sleep quality. [19] (10.2147/nss.s381918)
  • [L3] Sleep disturbance is common after rotator cuff repair, with sleep quality worsening at 2 weeks and improving beyond baseline by 6 weeks. [20] (10.1016/j.jse.2026.02.011)
  • [L1] Compared to placebo, melatonin did not significantly affect baseline, follow-up, or change in sleep quality (PSQI), pain (VAS), and quality of life (SF-36) scores. [21] (10.1016/j.injury.2022.10.011)
  • [L1] Given the low quality of evidence, minor degree of VAS score reduction, and inconclusive trial sequential analysis of postoperative opioid consumption, this metaanalysis neither supports nor opposes the effect of melatonin on postoperative pain. [22] (10.1111/papr.12948)

References

[1] Effects of Melatonin on Sleep Quality and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Surgery: A Prospective Randomized Controlled Trial. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241272076

[2] Evaluating Whether Melatonin Impacts Postoperative Sleep Following Total Joint Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Cureus. 2026. DOI: 10.7759/cureus.107734

[3] Effects of melatonin on postoperative sleep quality: a systematic review, meta-analysis, and trial sequential analysis. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2023. DOI: 10.1007/s12630-023-02442-1

[4] Limited Efficacy of Pharmacological Interventions for Improving Postoperative Sleep Quality in Primary Total Joint Arthroplasty Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.08.071

[5] Efficacy and effectiveness of melatonin for the management of musculoskeletal pain: a systematic review and meta-analysis of placebo and active controlled trials. Pain. 2026. DOI: 10.1097/j.pain.0000000000004045

[6] Perioperative Use of Melatonin in Joint Arthroplasty: A Critical Systematic Review of Randomized Clinical Studies. Journal of Pain & Palliative Care Pharmacotherapy. 2025. DOI: 10.1080/15360288.2025.2490654

[7] Melatonin Does Not Improve Sleep Quality in a Randomized Placebo-controlled Trial After Primary Total Joint Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-21-00243

[8] Improvements in Sleep After Shoulder Arthroscopy Are Correlated With Improvements in Various Patient‐Reported Outcomes: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100883

[9] The John N. Insall Award: Does Melatonin Improve Subjective Sleep Quality After Total Knee Arthroplasty? A Randomized, Placebo-Controlled Trial. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.01.018

[10] Does Melatonin Improve Sleep Following Primary Total Knee Arthroplasty? A Randomized, Double-Blind, Placebo-Controlled Trial. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.02.031

[11] Which Interventions Are Effective in Treating Sleep Disturbances After THA or TKA? A Systematic Review. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003196

[12] Effects of pharmacological therapy on sleep quality in a postoperative setting: A systematic review of randomized controlled trials. Journal of Anaesthesiology Clinical Pharmacology. 2024. DOI: 10.4103/joacp.joacp_428_23

[13] Exogenous melatonin in the treatment of pain: a systematic review and meta-analysis. Oncotarget. 2017. DOI: 10.18632/oncotarget.21504

[14] Does Melatonin Improve Sleep Following Primary Total Hip Arthroplasty? A Randomized, Double-Blind, Placebo-Controlled Trial. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.038

[15] Sleep quality and response after rotator cuff repair, total shoulder arthroplasty, and reverse shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2025.05.034

[16] Sleep alterations following elective shoulder surgery: A systematic review. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231220342

[17] Impact of Melatonin on Sleep and Pain After Total Knee Arthroplasty Under Regional Anesthesia With Sedation: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. The Journal of Arthroplasty. 2015. DOI: 10.1016/j.arth.2015.06.034

[18] Orthopedic sleep and novel analgesia pathway: a prospective randomized controlled trial to advance recovery after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.02.035

[19] Effects of Melatonin Treatment on Perioperative Sleep Quality: A Systematic Review and Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Nature and Science of Sleep. 2022. DOI: 10.2147/nss.s381918

[20] How patients sleep after rotator cuff repair: a prospective analysis of pain, position, and recovery. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.011

[21] Effectiveness of melatonin treatment for sleep disturbance in orthopaedic trauma patients: A prospective, randomized control trial. Injury. 2022. DOI: 10.1016/j.injury.2022.10.011

[22] Effect of Melatonin on Postoperative Pain and Perioperative Opioid Use: A Meta‐analysis and Trial Sequential Analysis. Pain Practice. 2020. DOI: 10.1111/papr.12948

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