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

Control group. We performed the same preliminary procedures with patients in the control group (ie, they selected cassette tapes, staff members checked the cassette recorder functions, patients indicated preferred music volumes). These patients, however, did not receive the music treatment in the OR or PACU.

Both groups. Patients in both groups had similar demographic characteristics and comparable surgical times. They underwent identical surgical procedures (ie, elective lumbar microdiscectomies), received the same preoperative medications (ie, midazolam hydrochloride, fentanyl citrate), were maintained intraoperatively on the same anesthesia protocol (ie, induction, succinylcholine chloride; inhalation, isoflurane, oxygen; paralyzed with vecuronium bromide; reversed with neostigmine bromide and glycopyrrolate), and received the same postoperative IV analgesic medications (ie, both groups were started on IV patient-controlled analgesia [PCA] pumps before leaving the PACU and maintained on PCA pumps during the first 24 hours after surgery).

We used standard PCA pumps for the patients' postoperative pain management. Staff members in the hospital's biomedical engineering department calibrated the pumps at the beginning of the study and checked their accuracy against the manufacturer's specifications and tolerance parameters. We completed the study within six months of the initial PCA pump calibration and accuracy checks.

Instruments. Adults' pain and affective distress can be measured accurately with reliable, valid instruments that have endpoints and carefully selected adjective descriptors.(18) We measured patients' postoperative pain levels using a standardized VAS (ie, "flame" scale) that corresponded to a numeric scale (ie, 0 = no pain, 10 = the most pain). Patients used this scale to identify their pain intensities after one hour in the PACU and again 24 hours later. We simultaneously used the same VAS to measure patients' anxiety levels (ie, 0 = no anxiety, 10 = the worst anxiety) after one hour in the PACU and again 24 hours later.

Data collection. Each patient could receive a maximum dose of 1 mg morphine sulfate IV every six minutes by activating the PCA pump. An investigator recorded the amount of IV morphine sulfate that each patient required, beginning with the time of the patient's arrival in the PACU and ending 24 hours later. We also recorded bolus analgesic medications and added these doses to the total amount of IV morphine sulfate used. Each patient's vital signs (ie, blood pressure, pulse and respiratory rates) were recorded every 15 minutes during the first hour in the PACU and every four hours thereafter. We administered a brief questionnaire 24 hours after PACU discharge to assess patients' satisfaction with their emergence from anesthesia and their postoperative pain management.

Data analysis. We obtained physiologic parameter data from all 34 patients and patient satisfaction with music data from 14 patients. Before we could analyze differences between the two groups of patients, we had to eliminate patients who could not complete the anesthesia protocol or for whom we lacked complete data. The final sample size of 10 patients (ie, five treatment group patients, five control group patients matched for gender and age) prohibited the use of inferential statistics; therefore, we used descriptive statistics to analyze group differences in analgesic medication requirements, pain and anxiety levels, and patient satisfaction.