The use of music during the immediate postoperative recovery period

AORN Journal, April, 1997 by Regina M. Heiser, Kathleen Chiles, Mary Fudge, Susan E. Gray

Management of patients' acute pain in the immediate postoperative period is challenging. Poor management of this pain can contribute to patient dissatisfaction, delayed healing, and prolonged hospitalization.(1) During the past two decades, health care professionals and other individuals interested in pain management have begun to recognize inadequacies in acute pain management and have developed position statements about therapeutic approaches to pain associated with operative and other invasive procedures and trauma injuries.(2) Although these efforts have focused on pharmacologic management of pain, the most effective relief of acute pain may be achieved by combining pharmacologic agents and noninvasive, nonpharmacologic interventions.(3)

Pain is a multifaceted phenomenon composed of physiologic, psychosocial, cultural, and subjective components. Health care professionals have implemented multiple diversion techniques (eg, relaxation, therapeutic touch, music therapy) to decrease patients' perceptions of pain, reduce adverse stimulation caused by pain, decrease pain-related anxiety, promote muscle relaxation at pain sources, and increase patients' satisfaction with the management of their pain.(4) For many individuals, music is a source of pleasure and, therefore, may be preferable to other diversion techniques.

Music has played an important role in health care and healing since the beginning of recorded history. Ancient Egyptians used music to bestow fertility, and more recently, researchers have studied music's effects on the human psyche and physiology in structured biophysiologic experiments.(5) Music therapy is a recognized science of systematically applying music to treat the physiologic and psychological aspects of patients' illnesses and disabilities.(6) Although many researchers have published results of music therapy studies, only a few have focused on patients' use of music during the immediate postoperative period.(7)

RATIONALE FOR STUDY

Perioperative practice settings are prime examples of the pervasiveness of advanced biotechnology in modern health care. As such, these settings provide a challenge and an opportunity for perioperative nurses to blend alternative therapies with technology to provide holistic patient care. Nurse researchers need to investigate and report nursing interventions that directly affect surgical patients' pain, anxiety, and satisfaction during the perioperative period. These interventions not only benefit patients, but also contribute to the growing body of nursing knowledge and the advancement of nursing as an autonomous profession.

We designed this study to investigate the effects of a noninvasive, nonpharmacologic intervention (ie, music) used in combination with a pharmacologic agent (ie, IV morphine sulfate) on surgical patients postoperative pain and anxiety levels, physiologic parameters, and satisfaction. We decided to study patients who listened to music during the last 30 minutes of their surgical procedures and the first hour in the postanesthesia care unit (PACU) and to compare them with similar patients who did not listen to music. We hypothesized that we could use music as an adjuvant therapy to reduce surgical patients pain and anxiety levels and promote their sense of well-being during the perioperative period.

LITERATURE REVIEW

One of the earliest nursing research studies on this topic evaluated the effects of music on patients postoperative pain, analgesic medication requirements, and physiologic parameters. Patients in this study who listened to music had less pain during the first 24 hours after their surgical procedures and had lower blood pressures, heart rates, and analgesic requirements during the first 48 hours after surgery than control-group patients who did not listen to music.(8) More recently, a nurse researcher studied the effects of music on patients feelings of autonomy during elective surgical procedures performed without general anesthesia. Patients in this study who listened to music during their surgical procedures reported a greater sense of control and comfort than patients who did not listen to music.(9) A group of anesthesia care providers examined the effects of music on phenomena that patients experience during emergence from ketamine hydrochloride anesthesia (eg, visual, auditory hallucinations; confusion) and reported that music did not affect these phenomena; however, patients in this study who listened to music were more satisfied with their emergence from anesthesia.(10)

Postanesthesia care unit nurses studied the effect of music on patients acute postoperative pain. They reported no differences in pain levels, analgesic medication requirements, physiologic parameters, or length of PACU stay among patients in three study groups (ie, standard PACU care, headphones with no music, headphones with music) during the PACU stay; however, patients who received music required less analgesic medication after discharge from the PACU and reported greater satisfaction.(11) Another group of nurse researchers used healthy female volunteers to compare the effects of stimulating and soothing music on subjects pain and tactile thresholds, heart rates, and blood pressures. Stimulating music elevated pain and tactile thresholds, whereas soothing music elevated only the pain thresholds. These researchers concluded that music alone or in combination with analgesic medications could help postoperative patients achieve pain control and autonomy.(12) Physiologic studies have documented significant immune responses in patients who listen to music of their choice. These immune responses (eg, increased interleukin-1 and salivary immunoglobulin A levels, decreased serum cortisol levels) protect patients from bacteria and promote the growth of specific lymphocytes that help postoperative patients heal.(13)