Postoperatif Ağrı Tedavisinde Melatoninin Rolü
Özet
Epifiz bezinden salgılanan endojen bir hormon olan melatonin, esasen sirkadiyen ritmin düzenlenmesinde rol almakla birlikte günümüze kadar yapılan çalışmalarda melatoninin ayrıca antiinflamatuar, antioksidan, antinosiseptif ve antidepresan etkilere sahip olduğu gösterilmiştir. Melatoninin rol aldığı bu fizyolojik ve patofizyolojik süreçlerin içerisinden antinosiseptif etkinliği, çalışmalarda en çok yer bulan özelliğini oluşturmuştur. Melatoninin analjezik etkisi çeşitli nosiseptif ve nöropatik ağrı modellerinde test edilmiştir. En önemli etki mekanizmalarından biri, spinal kord, talamus, hipotalamus, spinal trigeminal yol ve trigeminal nukleus gibi ağrı kontrolünde rol alan bölgelere dağılmış olan, MT1 ve MT2 olarak adlandırılan melatonin reseptörlerinin aktivasyonudur. Melatoninin ayrıca antiinflamatuar ve antioksidan etkisinin de analjezik özelliğine katkı sunması olasıdır. Ancak klinik araştırmalara göre melatoninin antinosisepsiyon etkileri halen tartışmalıdır. Bu yazının amacı perioperatif periyotta kullanılan melatoninin postoperatif analjezi üzerine etkilerini klinik çalışmaların sonuçları doğrultusunda değerlendirmektir.
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