Melody or Medication? Music is Viable Alternative to Sedatives to Calm Pre-op Patients

Music is a viable alternative to sedative medications in reducing patient anxiety prior to an anesthesia procedure, according to a Penn Medicine study published today in the journal Regional Anesthesia & Pain Medicine.

A peripheral nerve block procedure is a type of regional anesthesia – done in the preoperative area under ultrasound guidance – that blocks sensations of pain from a specific area of the body. The procedure is routinely performed for a variety of outpatient orthopedic surgeries, such as hip and knee arthroscopies and elbow or hand surgeries. To reduce anxiety, which can lead to prolonged recovery and an increase in postoperative pain, patients commonly take sedative medications, like midazolam, prior to the nerve block procedure. Yet, the medications can have side effects, including breathing issues and paradoxical effects like hostility and agitation. In this study, researchers found a track of relaxing music to be similarly effective to the intravenous form of midazolam in reducing a patient’s anxiety prior to the procedure. 

“Our findings show that there are drug-free alternatives to help calm a patient before certain procedures, like nerve blocks,” said the study’s lead author Veena Graff, MD, an assistant professor of Anesthesiology and Critical Care. “We’ve rolled out a new process at our ambulatory surgical center to provide patients who want to listen to music with access to disposable headphones. Ultimately, our goal is to offer music as an alternative to help patients relax during their perioperative period.”

While research has shown music can help reduce a patient’s anxiety prior to surgery, previous studies have primarily focused on music vs. an oral form of sedative medications, which are not routinely used in the preoperative setting. In this study – the first to compare music medicine with an intravenous form of sedative medication – researchers aimed to measure the efficacy of music in lowering a patient’s anxiety prior to conducting a peripheral nerve block.  

The team randomly assigned 157 adults to receive one of two options three minutes prior to the peripheral nerve block: either an injection of 1-2 mg of midazolam, or a pair of noise canceling headphones playing Marconi Union’s “Weightless,” – an eight-minute song, created in collaboration with sound therapists, with carefully arranged harmonies, rhythms, and bass lines designed specifically to calm listeners down. Researchers evaluated levels of anxiety before and after the use of each method, and found similar changes in the levels of anxiety in both groups.

However, the team noted that patients who received midazolam reported higher levels of satisfaction with their overall experience and fewer issues with communication. Researchers attribute these findings to a number of factors, including the fact they used noise canceling headphones, didn’t standardize the volume of music, and didn’t allow patients to select the music.

Reference: Veena Graff, Lu Cai, Ignacio Badiola and Nabil M Elkassabany. Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study. Regional Anesthesia & Pain Medicine, 2019 DOI: 10.1136/rapm-2018-100251

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