‘World’s most relaxing song’ as good as midazolam before surgery

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MusicMusic medicine may be offered as an alternative to midazolam administration prior to peripheral regional anesthesia, found a small UK study.

Listening to the “world’s most relaxing song” before an operation could be just as good at calming patients’ nerves as medication, BBC News reports US researchers say. The song, written to reduce anxiety, blood pressure and heart rate, performed as well as a sedative in a study of 157 people.

But patients said they would have preferred to choose their own music. And noise-cancelling headphones made communication harder, doctors said.

The report says the University of Pennsylvania researchers now want to look at whether the type of music and how it is played to patients makes a difference to the results.

The patients in the trial were either given the drug midazolam or played the song Weightless by UK band Marconi Union for three minutes, while having an anaesthetic to numb a region of the body. The report says patient anxiety reduced by the same amount in both groups.

Feeling anxious before surgery can affect recovery because of the stress hormones produced in the body. But drugs that reduce anxiety can have side-effects and need constant monitoring by doctors, the researchers from University of Pennsylvania are quoted in the report as saying. Music medicine, in contrast, was “virtually harm-free and inexpensive”.

Dr Veena Graff, assistant professor of anaesthesiology and critical care from University of Pennsylvania Perelman School of Medicine, said: “Music lights up the emotional area of the brain, the reward system and the pleasure pathways.

“It means patients can be in their own world, they can be comfortable and have full control.”

The report says music has been an invaluable tool in medicine for many years. It has been used during brain surgery, in patients such as Musa and Anna Marie, to monitor brain function.

Music can heal, stimulate and soothe the mind and body in many ways – but , as yet, the report says, scientists don’t properly understand how.

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.

Veena Graff, Lu Cai, Ignacio Badiola, Nabil M Elkassabany

BBC News report
BMJ abstract

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