Using Music Interventions in Perioperative Care

Lori Gooding, PhD, MT-BC; Shane Swezey, BM, MT-BC; Joseph B. Zwischenberger, MD


South Med J. 2012;105(9):486-490. 

In This Article

Music in the Preoperative Stage

Surgical procedures are often unfamiliar, uncomfortable, and can lead to undesirable results; therefore, even minor procedures can produce anxiety in patients. Research suggests that anxiety affects postoperative recovery, decreasing pain tolerance and impeding wound healing.[6] The research also suggests, however, that a reduction in preoperative anxiety can lead to decreased pain, vomiting, surgical complications, and recovery times.[3] Therapeutic music interventions have been suggested as a promising tool to facilitate positive patient outcomes.[4]

Music is primarily used during the preoperative period to reduce anxiety and increase relaxation, which is usually accomplished through passive music listening. This use of music has been referred to as "audioanalgesia," "audioanxiolytic," and "audiorelaxation."[3] In 2008, Nilsson conducted a systematic review of the anxiety- and pain-reducing effects of music in 42 randomized controlled trials.[3] Of the 42, 10 occurred during the preoperative period; 9 of these studies addressed patient anxiety. Types of surgical procedures included day surgery, breast biopsy, and elective surgery. Results of the review indicated that five of the nine studies demonstrated significant reductions in anxiety scores.[3]

Other studies support listening to music before surgery to reduce anxiety.[6,10–13] Ni et al concluded in their 2011 investigation involving passive music listening via headphones that day surgery patients may benefit significantly from musical intervention.[11] Bringman et al studied elective day or short-stay surgery patients randomized to either oral midazolam or passive music listening groups. Patients in the music group were allowed to select from music carefully chosen by a music therapist to reflect relaxing properties (ie, no words, tempi between 60 and 80 beats per minute, and consistent dynamic presentation). Results indicated that the music decreased anxiety levels to a greater extent than orally administered midazolam.[12] Pittman analyzed 11 studies in which the State-Trait Anxiety Inventory was used to determine patient anxiety levels pre- and postmusic intervention. Results from all 11 studies demonstrated decreased anxiety levels following music interventions.[5] Likewise, Wang et al found a 16% decrease in state anxiety in patients who listened to 30 minutes of patient-selected music preoperatively.[13]

The bulk of the preoperative studies focus on passive, music medicine–based interventions. A review of music therapy–specific literature revealed a small number of studies addressing pediatric patients.[14,15] Robb et al examined the effects of preferred music listening combined with music-assisted relaxation techniques facilitated by a music therapist. Results showed a significant reduction in anxiety and smoother transitions into the operating room.[14] Whipple provided case examples of active music therapy (ie, participatory) in pediatric patients during the preoperative period. The author suggested that music therapists were able to provide therapeutic support via music therapy interventions, thereby reducing both patient and parent anxiety.[15] DeMarco and colleagues examined the effect of music on stress and anxiety in patients undergoing elective cosmetic surgery. This study, which involved both medical and music therapy professionals, found an 18% reduction in anxiety in individuals who received music during the preoperative period versus those who did not.[16]