Surgery, regardless of whether it is performed in a hospital or day surgery setting, is a well-recognized cause of stress. Anxiety; metabolic, neurohormonal, and immune system changes; cardiovascular alterations; and increased levels of cortisol and natural killer lymphocytes are all associated with stress.
Numerous studies have shown that music therapy can inhibit stress, reducing the neurohormonal responses to psychological stress as well as preoperative anxiety and postoperative pain. The most suitable type of music to use for music therapy, however, is still a matter of debate. The primary purpose of this randomized study was to examine the role of music therapy in reducing stress associated with day surgery by evaluating changes in plasma levels of cortisol and natural killer lymphocytes, both of which are known to increase during stress. A secondary objective was to determine the effect of different types of music (ie, new age, patient selected).
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Between January and December 2005, 60 patients undergoing surgery at a day surgery unit of a university hospital in Italy were randomly assigned to one of three groups, with 20 patients in each group. Patients in group I listened to a compilation of relaxing new age music via headphones before and during surgery. On the morning of admission for day surgery, patients in group II chose the type of music they would listen to from a selection of classical, country, pop, and dance music compilations, and listened to their musical choice via headphones before and during surgery. Patients in group III (ie, the control group) did not listen to music before or during surgery.
Patients in the music therapy groups listened to music from one hour before surgery until the end of the surgical procedure. All of the surgical procedures were performed without general anesthetics or analgesics and were performed between 9 AM and 1 PM. The preoperative anxiety level of all patients was evaluated on admission using the Hamilton Anxiety Scale. A sample of blood was collected immediately before, during, and three hours after surgery and tested for cortisol levels and lymphocyte counts, including natural killer lymphocyte cell counts. The blood pressure, heart rate, and respiratory rate of all patients were recorded at the same times. Postoperatively, pain was assessed using a visual analogue scale and by noting the doses of analgesic required. Common statistical techniques, including analysis of variance and the Duncan multiple range test, were used to analyze differences between the groups.
FINDINGS. Plasma levels of cortisol and natural killer lymphocytes decreased during surgery in the groups that listened to music but increased during surgery in the control group. Intraoperative levels of natural killer lymphocytes were significantly lower in group I than in group III (mean [M] 212.2 cells/mcL versus 329.1 cells/mcL, P < .05). Postoperatively, cortisol levels were significantly higher in group I than in group II (M 14.21 nanograms [ng]/mL versus 8.63 ng/mL, respectively; P < .05).
CLINICAL IMPLICATIONS, The results of this study demonstrated that perioperative music therapy decreased stress as measured by the cortisol level and natural killer lymphocyte count. Additionally, music of a style selected by the patient appeared to be more effective overall in reducing stress. Perioperative nurses and managers should understand that the results of this study suggest that music therapy, particularly if the patient is allowed to choose the style and type of music, appears to have positive effect, and they should consider evaluating music therapy as part of their surgical routine.
Leardi S, Pietroletti R, Angeloni G, Necozione S, Ranalletta G, Del Gusto B. Randomized clinical trial examining the effect of music therapy in stress response to day surgery. Br J Surg. 2007;94(8):943-947.
GEORGE ALLEN
PHD, RN, CNOR, CIC
DIRECTOR OF INFECTION CONTROL
