Perioperative Anxiety
Conditions
Keywords
Individualized Music, Music Therapy, Perioperative Anxiety, Regional Anesthesia, Propofol, Sedation, Bispectral Index, State-Trait Anxiety Inventory
Brief summary
Perioperative anxiety is common among patients undergoing surgery under regional anaesthesia. Intravenous sedative-hypnotic agents such as propofol are commonly administered to reduce anxiety and improve patient comfort; however, pharmacological sedation may reduce patient alertness and cause cardiorespiratory adverse effects. Music may provide a non-pharmacological alternative for reducing perioperative anxiety. This prospective controlled study compared professionally prescribed individualized music with intravenous propofol sedation in adult patients undergoing surgery under regional anaesthesia. Participants in the music group received an individualized playlist curated by a professional music therapist following assessment of their music preferences and listening history. Participants in the sedative-hypnotic group received intravenous propofol sedation titrated according to clinical assessment. Perioperative anxiety was assessed before and after surgery using the State-Trait Anxiety Inventory-State (STAI-S) and a visual analogue scale (VAS). Intraoperative sedation and alertness were assessed using the Bispectral Index (BIS) and Modified Observer's Assessment of Alertness/Sedation (mOAA/S), together with haemodynamic monitoring and patient satisfaction.
Detailed description
This was a prospective, single-centre, parallel-group controlled study conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. Adult patients scheduled for surgery under regional anaesthesia were allocated to either a music-therapy group or a sedative-hypnotic group according to their scheduled operating day. Participants assigned to the music intervention underwent a preoperative assessment by a professional music therapist. The assessment included the participant's music-listening history and preferences, following which an individualized playlist was curated for intraoperative listening through headphones. Participants assigned to the sedative-hypnotic group received intravenous propofol using target-controlled infusion, titrated according to clinical assessment and sedation monitoring. Anxiety was evaluated preoperatively and postoperatively using STAI-S and an anxiety VAS. Intraoperative BIS, mOAA/S, haemodynamic variables and relevant rescue interventions were recorded. Postoperative patient satisfaction was also assessed. The study received approval from the Medical Research Ethics Committee, University Malaya Medical Centre (MREC ID 2023418-12366), before participant recruitment, and written informed consent was obtained from all participants. The study was completed before registration on ClinicalTrials.gov.
Interventions
BEHAVIORALProfessionally Prescribed Individualized Music
Participants underwent a preoperative music assessment by a professional music therapist that included music-listening history and individual preferences. Based on this assessment, the music therapist curated an individualized playlist for each participant. The prescribed music was delivered intraoperatively through headphones during surgery under regional anaesthesia. Participants remained awake without routine intravenous sedation, although rescue sedation could be administered when clinically required.
DRUGpropofol
Participants received intravenous propofol sedation by target-controlled infusion during surgery under regional anaesthesia. Sedation was titrated according to clinical assessment using Bispectral Index (BIS) and Modified Observer's Assessment of Alertness/Sedation (mOAA/S) monitoring.
Sponsors
University of Malaya
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
Participants and investigators administering the interventions were not masked because of the nature of the interventions. Postoperative outcome assessment was performed by a research assistant who was blinded to group allocation. The statistician conducting the original analysis was also blinded to group allocation.
Intervention model description
Participants were assigned to one of two parallel intervention groups according to the scheduled day of surgery. Participants scheduled on Tuesday or Thursday received intravenous propofol sedation, while participants scheduled on Wednesday or Friday received professionally prescribed individualized music.
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 to 70 years. * American Society of Anesthesiologists (ASA) physical status I or II. * No sedative or anxiolytic medication received before surgery that could affect measurement of vital signs or Bispectral Index (BIS). * Able to understand and communicate in Malay or English, understand the purpose and objectives of the study, and provide written informed consent. * Surgery planned under regional anaesthesia (spinal, epidural, or peripheral nerve block). * Surgery performed in the supine position.
Exclusion criteria
* Received general anaesthesia. * Refused to participate. * Hearing impairment. * Diagnosed neurocognitive or psychiatric disorder. * Aggressive or uncooperative behaviour. * Surgery duration exceeding 3 hours.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in State Anxiety Measured by the State-Trait Anxiety Inventory-State (STAI-S) | Perioperative period: During preoperative assessment at the operating theatre reception bay; And during postoperative assessment in the post-anaesthesia recovery room, on the day of surgery | State anxiety was assessed using the 20-item State-Trait Anxiety Inventory-State (STAI-S) before and after surgery. The total score ranges from 20 to 80, with higher scores indicating greater state anxiety. The outcome was the change in STAI-S score from the preoperative to the postoperative assessment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Anxiety Visual Analogue Scale (VAS) Score | Perioperative period: During preoperative assessment at the operating theatre reception bay; And during postoperative assessment in the post-anaesthesia recovery room, on the day of surgery | Anxiety was assessed using a Visual Analogue Scale (VAS) ranging from 1 (least anxious) to 10 (most anxious), with higher scores indicating greater anxiety. The outcome was the change in VAS score from the preoperative to the postoperative assessment. |
| Intraoperative Bispectral Index (BIS) | Every 10 minutes from the start of surgery until completion of surgery. | Depth of sedation was assessed using the Bispectral Index (BIS). BIS values were recorded at 10-minute intervals during surgery to assess the level of sedation during the assigned intervention. |
| Intraoperative Level of Sedation Measured by Modified Observer's Assessment of Alertness/Sedation (mOAA/S) | Every 10 minutes from the start of surgery until completion of surgery. | Alertness and sedation were assessed using the modified Observer's Assessment of Alertness/Sedation (mOAA/S) scale, ranging from 0 to 5. A score of 5 indicates that the participant is alert and responds readily to their name spoken in a normal tone, whereas a score of 0 indicates no response to a painful trapezius squeeze. Higher scores therefore indicate greater alertness and lower levels of sedation. mOAA/S was assessed at 10-minute intervals during surgery. |
| Intraoperative Systolic Blood Pressure | Every 10 minutes from the start of surgery until completion of surgery. | Systolic blood pressure was recorded at 10-minute intervals during surgery to assess haemodynamic changes during the assigned intervention. |
| Intraoperative Diastolic Blood Pressure | Every 10 minutes from the start of surgery until completion of surgery | Diastolic blood pressure was recorded at 10-minute intervals during surgery to assess haemodynamic changes during the assigned intervention. |
| Intraoperative Heart Rate | Every 10 minutes from the start of surgery until completion of surgery | Heart rate was recorded at 10-minute intervals during surgery to assess haemodynamic changes during the assigned intervention. |
| Postoperative Patient Satisfaction | Postoperative period: During assessment in the post-anaesthesia recovery room, on the same day of surgery | Overall satisfaction with the intervention provided during surgery was assessed using a verbal numerical rating scale ranging from 1 (least satisfied) to 10 (most satisfied), with higher scores indicating greater satisfaction. |
Countries
Malaysia
Contacts
PRINCIPAL_INVESTIGATORMOHD FITRY BIN ZAINAL ABIDIN
University of Malaya
Outcome results
None listed