SUMMER 2010

Effects of Perioperative Music on Anxiety, Hemodynamics, and Pain in Women Undergoing Mastectomy

Pamela Binns-Turner PhD CRNA, Gwendolyn Boyd MD, Lynda Harrison PhD FAAN, Jacqueline Moss PhD, and Erica Pryor PhD
University of Alabama at Birmingham
Carol Prickett, PhD
University of Alabama

Background

Mastectomy can produce significant stress and anxiety for women. Anxious patients often require larger amounts of anesthesia for induction and maintenance and manifest greater fluctuations in hemodynamics. (1)

• Elevated anxiety results in increased sympathetic nervous system activation with immune system depression and delayed wound healing (2)
• Music used as a non-pharmacologic intervention can reduce stress
• Prior studies suggest slow, soft, non-vocal music decreases physical and psychological indices of stress (3)

Patients and Methods

• Quasi-experimental, repeated measures design
• Convenience sample of 30 women ages 42-70 randomly assigned equally into music intervention and control groups
• Music intervention group selected and listened to music perioperatively (preop, intraop, postop)
• Music selections offered were inspirational, classical, easy listening, and new age
• Control group had headphones without music

Hypothesis

Women receiving a perioperative music intervention will have a significantly greater decrease in mean arterial pressure (MAP), heart rate, anxiety, and pain from time 1 (T1) to time 2 (T2).

Analysis

• Independent t-tests were used to analyze change scores resulting from T1 and T2 measurements on each dependent variable (MAP, HR, anxiety, pain)
• Study design minimized floor effect for anxiety, carefully controlled for surgical procedure, anesthetic, music application, blinding of observers, and homogeneous patient characteristics
• Participants were used as own control group

Results

Mean and Standard Deviation for Time 1, Time 2 and Change Scores

• Women in music group had decreased MAP, whereas women in control group had increased MAP
• No significant difference in heart rate change between women in music and control groups
• Women in music group had decreased anxiety, whereas women in control group had increased anxiety
• Women in music and control groups had increased pain, but the increase was significantly less for the women in the music group          

Discussion," "Implications for Practice

Discussion

Women in the music group had significantly lower MAP, anxiety, and pain.

• Findings support conceptual model which hypothesized that a perioperative music intervention can lower MAP, anxiety, and pain by reducing the stress response in women undergoing mastectomy through audioanalgesia, entrainment, and distraction which are all components of the Relaxation Response.
• Findings suggest that a perioperative music intervention can improve immediate postoperative outcomes for women undergoing mastectomy for breast cancer.

Implications for Practice

• Results are both statistically and clinically significant
• Music is a low cost and non-invasive intervention that is easily implemented in the perioperative setting reducing mean arterial pressure, anxiety, and pain in women undergoing mastectomy
• Several participants commented about how they enjoyed the music and it provided comfort to them
• Perioperative music is an efficacious intervention with the potential to improve patient outcomes and satisfaction

Future Research

• Expand perioperative music intervention to include other populations: men, children, other surgical procedures

References

1. Eisenman, A., & Cohen, B. (1995). Music therapy for patients undergoing regional anesthesia. AORN Journal, 62, 947-950.
2. Kim, J. J., & Yoon, K. S. (1998). Stress: Metaplastic effects in the hippocampus. Trends in Neuroscience, 21, 505-509.
3. Standley, J. M. (2000). Music research in medical treatment. In Effectiveness of music therapy procedures: Documentation of research and clinical practice (3rd ed.). Silver Spring, MD: American Music Therapy Association, Inc.

For additional information, please contact:

Pamela Binns-Turner PhD CRNA
Nurse Anesthesia
Union University School of Nursing
pturner@uu.edu

University of Alabama
School of Nursing