Effect of music on vital signs and postoperative pain

AORN Journal, August, 2004 by Eleni Ikonomidou, Anette Rehnstrom, Ole Naesh

Patients scheduled to undergo surgical procedures often say that they sense a loss of control and autonomy. This may induce anxiety and a feeling of helplessness, which also could be related to being in an unfamiliar environment. (1-4) Postoperative pain and nausea may prolong recovery, and the experience of psychological tension may affect the cardiovascular and immune systems. (5)

Pharmacological methods to improve postoperative pain and nausea are well documented, but an increasing interest in nonpharmacological methods--particularly pleasant auditory stimulation--has prompted research in this field. The use of music during and after surgery has attracted attention recently, and several studies and reviews on the topic have been published. (6-8) Although many of these have not fulfilled standard criteria for randomization and control of circumstances, some recent studies point to a direct pain-reducing effect from patients' perioperative exposure to music. (9-14)

Traditional and pharmacological therapeutic interventions for the relief of perioperative anxiety and pain are being challenged by an increasing demand for complementary and more holistic approaches. (15) Furthermore, there is increasing pressure on perioperative staff members to rush patients through the perioperative period. (16) Current therapeutic methods may, in fact, impair patient flow through recovery. Benzodiazepines and opioids--current standards of treatment for postoperative pain--have well-known sedative and emetic side effects. Reducing the dosages of these medications is essential for improving the logistics of postoperative care.

PURPOSE

The purpose of this study was to test the hypothesis that listening to relaxation music preoperatively and postoperatively would affect patients' experience of pain, nausea, or well-being and that it would have an effect on vital signs in women undergoing laparoscopic gynecological surgery.

Questions asked in the study include the following.

1. Does preoperative relaxation music influence patients' experience of well-being, and does it have any measurable impact on vital signs (ie, heart rate [HR], blood pressure [BP], and respiratory rate [RR])?

2. Does relaxation music played during the immediate recovery period affect patients' experience of pain, nausea, and well-being?

3. Does relaxation music played in the immediate recovery period affect the amount of analgesics and antiemetics administered during this period?

4. Does relaxation music played in the immediate recovery period affect HR, BP, and RR?

STUDY SIGNIFICANCE

The use of nonpharmacological and noninvasive methods increasingly is considered a means of alleviating anxiety and pain. If a measure as simple as playing music could influence patients' experience of perioperative anxiety and postoperative discomfort, it would have implications for the daily treatment of patients undergoing surgery. If effective, it might decrease the use of medications implicated in prolonging the recovery period. Such all effect would be especially important for same-day surgery because an uneventful and comfortable recovery period could reduce time spent in the physician's office or ambulatory surgery center.

METHODS

The study was conducted in a 1,200-bed hospital in Lund, Sweden. The hospital's ethics committee approved the study, and written informed consent was obtained from 60 patients with an American Society of Anesthesiologists' (ASA) rating of one to two who were between 25 and 45 years of age and were scheduled to undergo gynecologic laparoscopy under general anesthesia. Exclusion criteria based on the preoperative anesthesia care provider's review and a short interview by one of the authors on the morning of surgery were

* an ASA rating of greater than two,

* any psychiatric disorders,

* a history of alcohol or drug abuse,

* neurological disease,

* a first language other than Swedish,

* chronic pain problems,

* analgesic medication taken within the last week,

* allergy to any of the planned perioperative medications, and

* past complications during anesthesia or surgery.

The sample consisted of 60 consecutive patients having either laparoscopic sterilization or laparoscopic tubal dyeing as part of an infertility program. The patients were assigned randomly to either M group, who listened to peaceful pan flute music or C group, who listened to a blank compact disc (CD) prepared specifically for the study. The CDs were unmarked, and the content was unknown to the nurse starting the CD player.

Investigators called the patients one or two days before surgery for information and for their consent to participate in the study. A written consent form was obtained on the day of surgery.

The dependent variables measured were pain, nausea, well-being, vital signs, and total dose of analgesics and antiemetics administered during the recovery period. Pain was measured using a visual analogue scale (VAS) consisting of a blank line with endpoints of zero, indicating no pain, and 100, signifying the worst thinkable pain. Nausea was measured on a similar scale (ie, zero equals no nausea and 100 equals worst thinkable nausea). Well-being was measured on a VAS with endpoints of "calm" and "very anxious." The measuring device was a 10-cm, horizontal line with markings only at the ends (ie, "calm" and "very anxious"), and all measurements were taken by one of the researchers. The clinical use of VAS and verbal rating scales has been supported extensively in the literature. (5-17) The reliability estimate for the use of the VAS in this study was not calculated and, therefore, could not be reported.