Summary: Study shows listening to calming music before surgery has similar effects as midazolam in reducing anxiety before regional anesthesia is given.
Music may offer an alternative to the use of a drug routinely used to calm the nerves before the use of regional anesthesia (peripheral nerve block), suggest the results of a clinical trial, published online in the journal Regional Anesthesia & Pain Medicine.
It seems to have similar effects as the sedative midazolam in reducing anxiety before a peripheral nerve block-a type of anesthetic procedure done under ultrasound guidance and designed to numb a specific region of the body.
Preoperative anxiety is common, and it can raise levels of stress hormones in the body, which in turn can affect recovery after surgery.
It is usually treated with benzodiazepines, such as midazolam. But these drugs have side effects, including affecting breathing, disturbing blood flow, and paradoxically increasing levels of agitation and hostility. Use of these drugs also requires continuous monitoring by a skilled clinician.
Music medicine has been used to lower preoperative anxiety before, but it has not been directly compared with intravenous midazolam.
The researchers wanted to find out if it might offer a suitable alternative to midazolam to calm the nerves before carrying out a peripheral (regional) nerve block.
They randomly assigned 157 adults to receive either 1-2 mg of midazolam (80), injected 3 minutes before the use of a peripheral nerve block, or to listen to Marconi Union’s Weightless series of music via noise-canceling headphones (77) for the same period.
This track is considered to be one of the world’s most relaxing songs:
Song: Marconi Union – Weightless. Video credit: Just Music TV.
Levels of anxiety were scored using a validated measure (State Trait Anxiety Inventory-6, or STAI-6 for short) before and after the use of each anxiety calming method. Satisfaction among patients and doctors were scored on a 10-point scale, with 0 reflecting the lowest level of satisfaction.
Changes in the levels of preoperative anxiety were similar in both groups, although patients in the music group were less satisfied than those given midazolam, possibly because patients were not allowed to choose the music they listened to, suggest the researchers.
But there was no difference in satisfaction levels among doctors.
Both patients and doctors thought it was harder to communicate when music was used to calm nerves, possibly because of the use of noise-canceling headphones, and not standardizing the volume of the music, suggest the researchers.
They accept that a comparison lasting just 3 minutes may have been too short, but this period was chosen because that is how long it takes for midazolam to reach peak effectiveness. And they acknowledge that the measure used to assess satisfaction wasn’t a validated scale.
Nevertheless, their findings prompt them to conclude that music may be offered as an alternative to midazolam before carrying out a regional nerve block.
“However,” they caution, “further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.”
Veena Graff – BMJ
The image is in the public domain.
Original Research: Closed access
“Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study”. Veena Graff, Lu Cai, Ignacio Badiola and Nabil M Elkassabany.
Regional Anesthesia & Pain Medicine. doi:10.1136/rapm-2018-1002515
Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study
Background and objectives Music medicine is a non-pharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety. In this study we aim to compare the use of music to midazolam as a preoperative anxiolytic prior to the administration of an ultrasound-guided single-injection peripheral nerve block.
Methods In this randomized controlled study we compared the anxiolytic effects of intravenous midazolam (1–2 mg) with noise-canceling headphone-delivered music medicine. All patients received a preoperative ultrasound-guided single-injection peripheral nerve block indicated for a primary regional anesthetic or postoperative analgesia.
Results The change in the State Trait Anxiety Inventory-6 (STAI-6) anxiety scores from after to before the procedure were similar in both groups (music group −1.6 (SD 10.7); midazolam group −4.2 (SD 11); p=0.14; mean difference between groups −2.5 (95% CI −5.9 to 0.9), p=0.1). Patient satisfaction scores with their procedure experience were higher in the midazolam group (p=0.01); however, there were no differences in physician satisfaction scores of their procedure experience between groups (p=0.07). Both patient and physician perceptions on difficulties in communication were higher in the music group than in the midazolam group (p=0.005 and p=0.0007, respectively).
Conclusions Music medicine may be offered as an alternative to midazolam administration prior to peripheral regional anesthesia. However, further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.
Clinical trial registry Clinicaltrials.gov #NCT03069677