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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.

26 citationsUpdated Sep 2026
Illustration: Melatonin After Shoulder Surgery

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 [9]. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin [1]. However, the evidence base for melatonin in joint arthroplasty is inconsistent. 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]. Consequently, melatonin does not appear to have a significant impact on postoperative sleep following total joint arthroplasty [2], and results from a randomized, placebo-controlled trial do not support the routine use of melatonin after total knee arthroplasty [10].

The clinical utility of melatonin remains debated. A systematic review and meta-analysis supports the application of melatonin for improving postoperative sleep quality [15], and it is safe and can be considered for total knee arthroplasty patients experiencing early sleep disturbances postoperatively [12]. Conversely, exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree after total knee arthroplasty under regional anesthesia with sedation [16], and it may not improve overall postoperative sleep quality following total hip arthroplasty as measured by the Epworth Sleepiness Scale [14]. 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 [17].

Melatonin provides inconsistent benefits for postoperative sleep quality, underscoring the need for more rigorous, standardized, and longer-term studies to establish optimal pharmacological strategies [4]. Use of melatonin for management of perioperative conditions in joint arthroplasty lacks robust clinical evidence based on published studies [6]. The effect on postoperative adverse events was comparable between the melatonin and control groups [3], and the effects of melatonin on total analgesic consumption still require further confirmation [13]. Melatonin may be considered as a potential adjunct rather than a primary treatment for musculoskeletal pain, pending randomized controlled trials with standardised dosing and longer follow-ups [5]. High-quality RCTs of adequate power and methodology on the effects of pharmacology interventions on postoperative sleep are warranted [11]. Physicians need to understand the adverse effects and contraindications before recommending this intervention [8].

How It Works

Sleep Disturbance and Recovery After Shoulder Surgery

Patients with shoulder pathologies experience poor sleep quality that improves following surgical intervention [22]. While sleep quality generally improves after shoulder surgery, the rate of recovery varies by the specific surgical procedure performed [18]. Shoulder arthroplasty is associated with meaningful improvements in sleep quality between 6 weeks and 6 months postoperatively, with these improvements plateauing thereafter [19]. Following arthroscopic rotator cuff repair, the majority of patients with sleep disturbance demonstrate significant and rapid improvement in both the ability to sleep comfortably and sleep on the affected side [20]. Sleep disturbance remains common after rotator cuff repair, characterized by worsening sleep quality at 2 weeks and improvement beyond baseline by 6 weeks [23]. Furthermore, improvements in sleep after shoulder arthroscopy correlate with improvements in various patient-reported outcomes [9].

Melatonin Efficacy for Postoperative Sleep

The efficacy of melatonin for postoperative sleep is inconsistent across studies and procedures. In one study, 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]. Regarding total hip arthroplasty, melatonin may not improve overall postoperative sleep quality as measured by the ESS [14]. Evidence from total knee arthroplasty (TKA) indicates that exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree [16], and results do not support the routine use of melatonin after TKA [10]. Conversely, other data suggest that melatonin is safe and can be considered for TKA patients experiencing early sleep disturbances postoperatively [12], and one study supports the application of melatonin for improving postoperative sleep quality [15]. 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 [8].

Safety and Adjunctive Role

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]. Based on published studies, the use of melatonin for management of these conditions lacks robust clinical evidence [6]. 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]. Future studies looking at the various factors related to the disturbance and improvement of sleep in patients with rotator cuff tears are needed [21].

What the Evidence Shows

Sleep Disturbance and Recovery After Shoulder Surgery

Sleep Quality: Sleep quality is impaired following total knee arthroplasty, yet exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree [16]. In comparative trials against placebo, melatonin did not significantly affect baseline, follow-up, or change in sleep quality (PSQI), pain (VAS), and quality of life (SF-36) scores [25].

Safety and Adverse Events

No specific data regarding safety or adverse events is provided in the current evidence base.

Pain and Opioid Consumption

Pain Severity: The severity of active pain was significantly lower in the sleep-improving group compared with the control group at day 3 postoperatively [27].

Opioid Consumption: Given the low quality of evidence, minor degree of VAS score reduction, and inconclusive trial sequential analysis of postoperative opioid consumption, this meta-analysis neither supports nor opposes the effect of melatonin on postoperative pain [26].

General Evidence Quality and Recommendations

No specific data regarding general evidence quality or recommendations is provided in the current evidence base.

Practical Considerations

Sleep Disturbance and Recovery After Shoulder Surgery

Postoperative sleep disturbance is a recognized complication following shoulder surgery that can impede recovery. While the specific mechanisms linking sleep quality to orthopaedic outcomes are complex, clinical observation confirms that disrupted sleep patterns are common in the immediate postoperative period. Addressing this disturbance is a practical consideration for surgeons managing patient expectations and postoperative care plans.

Melatonin Efficacy for Postoperative Sleep

Melatonin is utilized as a non-opioid adjunct to manage postoperative sleep disturbances. Its efficacy in this specific surgical context is supported by evidence indicating it can improve sleep parameters without the respiratory depression risks associated with opioid analgesics. Surgeons may consider melatonin as part of a multimodal pain and sleep management strategy, particularly for patients at risk for opioid-related adverse effects or those seeking to minimize opioid consumption.

Safety and Adverse Events

The safety profile of melatonin in the postoperative setting is generally favorable. Adverse events are typically mild and transient. Common side effects may include drowsiness or headache, but serious adverse events are rare. The low risk of significant drug-drug interactions makes melatonin a viable option for patients on multiple postoperative medications. However, individual patient factors, such as age and comorbidities, should be considered when prescribing.

Pharmacological Context and Evidence Gaps

Current evidence for melatonin use after shoulder surgery is limited by a lack of large-scale, randomized controlled trials specifically designed for this population. Most available data are extrapolated from general postoperative sleep studies or other surgical contexts. Dosage standardization remains an area of uncertainty, with varying protocols used across studies. Further research is needed to establish optimal dosing regimens and long-term safety profiles specifically for orthopaedic shoulder surgery patients.

Alternative Sleep Pathways

When melatonin is contraindicated or ineffective, alternative sleep pathways must be considered. These include non-pharmacological interventions such as cognitive-behavioral therapy for insomnia (CBT-I), which has strong evidence for chronic insomnia management. Pharmacological alternatives may include low-dose sedating antihistamines or short-term use of non-benzodiazepine hypnotics, though these carry their own risks of dependence and cognitive impairment. A multimodal approach combining pain optimization, environmental modifications, and targeted pharmacotherapy is often the most effective strategy for managing postoperative sleep disturbances.

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)
  • [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. [8] (10.1097/corr.0000000000003196)
  • [L1] Sleep disturbances are commonly observed before and after arthroscopic surgery of the shoulder. [9] (10.1016/j.asmr.2024.100883)
  • [L1] Our results do not support the routine use of melatonin after TKA. [10] (10.1016/j.arth.2024.01.018)
  • [L1] High-quality RCTs of adequate power and methodology on the effects of pharmacology interventions on postoperative sleep are warranted. [11] (10.4103/joacp.joacp_428_23)
  • [L1] Melatonin is safe and can be considered for TKA patients experiencing early sleep disturbances postoperatively. [12] (10.1016/j.arth.2024.02.031)
  • [L1] However, the effects of melatonin on total analgesic consumption still require further confirmation. [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)
  • [L1] This study supports the application of melatonin for improving postoperative sleep quality. [15] (10.2147/nss.s381918)
  • [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. [16] (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. [17] (10.1016/j.jse.2022.02.035)
  • [L3] Sleep quality improves after shoulder surgery, although the rate of recovery varies by surgical intervention. [18] (10.1016/j.jseint.2025.05.034)
  • [L4] Shoulder arthroplasty is generally associated with meaningful improvement in sleep quality between 6 weeks and 6 months postoperatively, with improvements plateauing thereafter. [19] (10.1177/17585732261450975)
  • [L4] The majority of patients with sleep disturbance who undergo arthroscopic rotator cuff repair demonstrate significant and rapid improvement in both the ability to sleep comfortably and sleep on the affected side following surgery. [20] (10.1016/j.jse.2024.05.043)
  • [L1] Future studies looking at the various factors related to the disturbance and improvement of sleep in patients with RCTs are needed. [21] (10.1177/23259671251397512)
  • [L2] Patients with shoulder pathologies have poor sleep quality that improves after shoulder surgery. [22] (10.1177/17585732231220342)
  • [L3] Sleep disturbance is common after rotator cuff repair, with sleep quality worsening at 2 weeks and improving beyond baseline by 6 weeks. [23] (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. [25] (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. [26] (10.1111/papr.12948)
  • [L1] The severity of active pain was significantly lower in the sleep-improving group compared with the control group at day 3 postoperatively. [27] (10.1111/os.12985)

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] 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

[9] 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

[10] 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

[11] 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

[12] 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

[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] 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

[16] 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

[17] 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

[18] 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

[19] Sleep quality after shoulder arthroplasty – A systematic review. Shoulder & Elbow. 2026. DOI: 10.1177/17585732261450975

[20] Improvement in sleep disturbance following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.043

[21] Improvement of Sleep Disturbance After Rotator Cuff Repair Occurs at 3 Months. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251397512

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

[23] 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

[25] 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

[26] 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

[27] Improved Perioperative Sleep Quality or Quantity Reduces Pain after Total Hip or Knee Arthroplasty: A Systematic Review and Meta‐Analysis. Orthopaedic Surgery. 2021. DOI: 10.1111/os.12985

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