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Background and Aims The hospitalization of elderly patients for urgent surgeries has seen a significant increase in recent years due to demographic aging. These fragile patients are more vulnerable to perioperative anxiety, delirium, and postoperative pain. The objective of our study is to evaluate the effect of different dosages of melatonin on perioperative anxiety, perioperative stability, and the prevention of postoperative delirium in elderly patients admitted to theorthopedic department of CHU Fattouma Bourguiba for osteosynthesis of a fracture of the upper extremity of the femur.

Methods This is a prospective, randomized, double-blind study conducted in the operating rooms of the orthopedic surgery and traumatology department of CHU Fattouma Bourguiba, Monastir. We included 123 patients over 65 years old admitted for pertrochanteric fracture,divided into three groups: control group M0, group M3 (3 mg of melatonin), and group M6 (6 mg of melatonin). We evaluated perioperative anxiety, sedation, delirium, and postoperative pain.

Results The majority of patients were female with a mean age of 78.8±9.2 years, ranging from 65 to 101.The majority of patients had an ASA score of 2 (74%). A comparison of the three study groups, after premedication revealed: A lower anxiety score (VAS) in the M3 and M6 groups than in the control group. A lower level of sedation in the control group. Better hemodynamic stability in the M6 group. Analysis of postoperative data showed:A dose-dependent analgesic effect of melatonin, with the M6 group being superior to the other groups.

Conclusions Melatonin has demonstrated numerous benefits in theperioperative management of elderly patients.