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

LIMITATIONS

A small sample size was the major limitation of this study. We needed 60 patients (ie, 30 in each group) to determine if music would have a significant effect on patients' physiologic parameters during their emergence from anesthesia and postoperative recovery and on their postoperative pain and anxiety levels and analgesic medication requirements. The following factors limited our ability to enroll and collect complete data for the required number of patients and made continuation of our study infeasible.

* All patients needed to be managed with a strict anesthesia protocol to isolate the effect of music. We had to eliminate several patients from the study because the anesthesia care providers needed the flexibility of administering various anesthetic agents to these patients.

* We originally planned to enroll other patient groups in the study (eg, patients undergoing laparoscopic cholecystectomy procedures or abdominal hysterectomy procedures with or without bilateral salpingo-oophorectomy). Our protocol required patients to use PCA pumps for postoperative analgesic management. Physicians increasingly were ordering epidural analgesic medications via PCA pumps for patients in these other groups, thus rendering them ineligible for our study.

* Additional research studies involving surgical patients commenced at our facility after we had begun collecting data. Some patients were approached and asked to participate in more than one study. We believed that this environment increased patients' anxiety levels, and we believed it would be unethical to ask these same patients to participate in our study.

We also did not or could not control some factors that may have influenced our patients' pain and anxiety levels. For example, we did not measure or control for patients' preoperative anxiety states or levels of pain. We only noted the type and amount of analgesic medications they were taking before surgery to exclude patients with chronic pain issues.

We also did not control for patients' preoperative knowledge of or experience with relaxation techniques. Some of our patients were using focal points and breathing exercises and others were using distraction techniques (eg, needlepoint, television) to manage their preoperative pain.

Patients in both groups received a single IV bolus dose of 8 mg morphine sulfate 30 minutes before their surgical procedures ended. We do not know how this intervention may have affected the treatment group patients' perception of music.

SUMMARY

Music appears to be a comforting, familiar dimension of personalization during a time when surgical patients have no control over their environments or bodies and are unaware of other caring messages and actions by perioperative staff members. In this study, patients reported that music was a satisfying noninvasive, nonpharmacologic intervention and stated that they would use music again if they required future surgical procedures.

Pain management is garnering increased attention as we approach the end of the twentieth century. Consumer groups are demanding information about patient satisfaction and comfort measures in acute care facilities. The Agency for Health Care Policy and Research clinical guidelines identify specific pain management responsibilities for facilities and health care professionals.(20) In this climate, perioperative team members must consider the advantages of noninvasive, nonpharmacologic interventions (eg, costs compared to medication costs, lack of side effects, ability of patients to retain control of their environments) when managing surgical patients' acute postoperative pain.