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Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 208-212  

Effect of spiritual music on old-age patients undergoing lower limb surgery under spinal anesthesia


Department of Anesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Submission09-Feb-2022
Date of Decision11-Jul-2022
Date of Acceptance18-Jul-2022
Date of Web Publication19-Sep-2022

Correspondence Address:
Dr. Ravi Prakash
Department of Anesthesiology, King George Medical University, Chowk, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aer.aer_25_22

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   Abstract 

Context: Music is ubiquitous and found in all cultures; it elicits both physiological and psychological responses in its listener. It has been proven that music reduces perception of pain and dosages of anesthetics and sedatives used during surgery. Aims: To study the effect spiritual music on perioperative anxiety and hemodynamic parameters in elderly patients undergoing procedures under spinal anesthesia. Settings and Design: A prospective, randomized controlled study. Subjects and Methods: Eighty patients fulfilling inclusion criteria were enrolled and randomly divided in two equal groups. Patients were transferred to the operation theater with the spiritual music still being played in Group I, while no music was played in Group C. Under aseptic precautions, neuraxial blockade was performed at L3/L4 interspace. Music was played throughout the surgery in Group I. Intraoperative visual analog scale for anxiety (VASA) was recorded. At the end of the surgery, spiritual music was stopped. The study parameters were recorded. Statistical Analysis Used: A significant difference in the proportions of male and female candidates between the two groups was calculated using Chi-squared test. Significant differences in the mean VASA scores and blood pressures (systolic blood pressure [SBP] and diastolic blood pressure [DBP]) between the two groups were calculated using Student's t-test. Results: No significant difference was observed between preoperative VASA score (P = 0.29) of both the groups, whereas a significant difference was present in intraoperative (P < 0.01) and postoperative VASA score (P < 0.01) of both the groups. In Group I, requirement for sedative was significantly lower (P < 0.01). Heart rate in Group I was on lower side, suggesting decrease in anxiety. No significant difference was observed in SBP or DBP of the patients of both the groups. Conclusions: Spiritual music can act as a noninvasive, simple, and inexpensive intervention for elderly patients to alleviate perioperative anxiety. It can also reduce the need for sedatives intraoperatively, thereby lowering the risk of side effects.

Keywords: Anxiety, sedation, spinal anesthesia, spiritual music, visual analog scale for anxiety


How to cite this article:
Singh P, Arya A, Singh MK, Prakash R, Khan MP. Effect of spiritual music on old-age patients undergoing lower limb surgery under spinal anesthesia. Anesth Essays Res 2022;16:208-12

How to cite this URL:
Singh P, Arya A, Singh MK, Prakash R, Khan MP. Effect of spiritual music on old-age patients undergoing lower limb surgery under spinal anesthesia. Anesth Essays Res [serial online] 2022 [cited 2022 Nov 28];16:208-12. Available from: https://www.aeronline.org/text.asp?2022/16/2/208/356415


   Introduction Top


Anxiety is an emotional human reaction, which can be defined as an uneasy feeling of discomfort or feeling of apprehension. The presence of anxiety is almost universal in the preoperative patient[1] and it may complicate the induction of anesthesia and may alter the pharmacokinetics of the agents used by inducing catecholamine release.[2] Most lower limb surgeries are performed under spinal anesthesia, and they hear all noises and conversations during their surgery which could make them anxious. This anxiety can increase the risk of psychological and physiological complications and delays in postoperative recovery.[3] For decreasing stress and anxiety, use of pharmacologic methods such as opioids and benzodiazepines may impair the recovery of patients due to their sedative and emetic effects and they also cause dose-dependent central nervous system and cardiorespiratory depression.[4],[5] Psychological and music intervention are safe, noninvasive methods that patients can accept easily.[6],[7] Pain-reducing effects of music are mediated by decrease in activity of stress responsive systems in body.[8] Music is primarily used during the peroperative period to reduce anxiety and increase relaxation, which is usually accomplished through passive music listening.[9] It is also found to enhance well-being and reduce stress by exerting direct physiologic effects through the autonomic nervous system. Calming music can alleviate perioperative pain and anxiety[9],[10] and may improve the hemodynamic status of patients.[11],[12]

We aimed to compare the effect of this preoperative and intraoperative exposure to spiritual music on perioperative anxiety and hemodynamic parameters in patients undergoing procedures under SAB versus patients who were not subjected to spiritual music.


   Subjects and Methods Top


It was a prospective, randomized controlled study done for a duration of 1 year in a tertiary care hospital. Ethical clearance was obtained from the institutional ethical committee (CTRI/2020/10/028583), and written informed consent was taken from patients and their attendants. The procedures followed the guidelines laid down in the Declaration of Helsinki. Eighty elderly patients fulfilling the inclusion and exclusion criteria were enrolled in the study and randomly divided into intervention (I) and control (C) groups.

Inclusion criteria

  1. Patient 60 years of age and above
  2. American Society of Anesthesiology Grade I and II
  3. Any lower limb surgery that can be done under sub arachnoid block
  4. Surgeries with a duration equal to and less than 3 h.


Exclusion criteria

  1. Any contraindication to spinal anesthesia
  2. Patients requiring intraoperatively any general anesthesia aid
  3. Deaf patients, mentally retarded, and dementia patients
  4. Patients with psychiatric disorder.


Methods

In the evening before surgery, patients fulfilling the inclusion criteria were asked a series of question-

  1. If he/she believes in worshipping?
  2. If he/she likes to listen to music?
  3. If he/she likes to listen spiritual music?
  4. If he/she would be comfortable listening to music while getting operated?


Upon answering yes for the above-asked questions, they were included for the study. Written informed consent was taken from the patients. Patients were randomly allocated to either music group (I) or usual care group (c).

On the day of surgery in the morning, patients were told about visual analog scale for anxiety (VASA). It consists of a 10-cm horizontal line with the descriptors “0 - no anxiety” at the left extent and “10 - worst possible anxiety” at the right extent (1).

The heart rate and systolic and diastolic blood pressure (SBP and DBP) were noted and patients were asked about VASA (preoperative) score. The noise cancellation headphones were applied to patients belonging to the music group, whereas headphones were not applied to patients belonging to usual care group. The spiritual music selected by researcher was played at the noise level comfortable to the patient for the duration of 30 min before taking patient to operation theater.

Patients were transferred to the operation theater with the spiritual music still being played. Standard monitors such as electrocardiography, pulse oximeter probe, and noninvasive blood pressure monitoring cuff were applied, and venous access was secured for administration of fluids. Under aseptic precautions, neuraxial blockade was performed at L3/L4 interspace. Hyperbaric bupivacaine (0.5%) (0.3 mL.kg−1) using a 25-gauge pencil point spinal needle in sitting position was injected to the patient at L3/L4 interspace. After achievement of effect of subarachnoid block up to desirable level, positioning of the patient was done. Patients with unsatisfactory block were excluded from the study.

Standard routine monitoring was done throughout surgery. Intraoperative VASA was recorded.[13] The need for any sedative for calming an anxious patient or need for rescue analgesic was noted.

At the end of the surgery, spiritual music was stopped. Patients were shifted out of the theater to the postoperative ward. One hour postoperatively in ward patient was asked about VASA score hemodynamic parameters were recorded. The requirement for any analgesic was noted.

Statistical analysis

A significant difference in the proportions of male and female candidates between the two groups was calculated using Chi-squared test. Significant differences in mean VASA scores and blood pressures (SBP and DBP) between the two groups were calculated using Student's t-test. Variation of observations from the mean values was shown using standard deviation (SD) (±).


   Results Top


The demogrphic variables in both groups have been compared in [Table 1].
Table 1: Basic demographic variable comparison in both the groups

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Preoperative VASA score, intraoperative VASA score, and postoperative VASA score were presented as mean and SD for both the groups. No significant difference was observed between preoperative VASA score (P = 0.29) of both the groups, whereas a significant difference was present in intraoperative (P < 0.01) and postoperative VASA score (P < 0.01) of both the groups [Table 2].
Table 2: Comparison of visual analog scale for anxiety scores between both groups

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In Group I, requirement for sedative was significantly lower intraoperatively in comparison to Group C (P < 0.01) [Table 3].
Table 3: Comparison of analgesic requirements between both groups

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Heart rate of the patients belonging to the music group was on lower side, suggesting a decrease in anxiety in comparison to patients of usual care group [Table 4]. No significant difference was observed in SBP or DBP of the patients of both the groups [Table 5] and [Table 6].
Table 4: Comparison of heart rate in both the groups

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Table 5: Comparison of systolic blood pressure in both the groups

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Table 6: Comparison of diastolic blood pressure in both the groups

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   Discussion Top


Anxiety is usually encountered in patients undergoing for surgery. Geriatric population is usually considered high risk for any kind of surgery and presence of anxiety in such patients only increases complications such as higher doses of sedatives have to be administered for calming such patients.

We conducted this study to observe the effect of spiritual music on anxiety level, any added sedatives or analgesic requirements intraoperatively, and on hemodynamic stability of old-age patients. No such study in our knowledge has been done on north Indian old-age population.

In our study, patients listened to spiritual music preoperatively using headphones till the end of surgery. The anxiety level was accessed at intervals using visual analog scale. Our study showed that patients who were subjected to spiritual music showed decreased anxiety levels as compared to group who were not subjected to music. Sedative and analgesic requirements were also low intraoperatively in the music group and they also showed heart rate on lower side.

In our study, we observed a significant difference in intraoperative and postoperative VASA score of patients who were subjected to spiritual music. This observation was supported by the study done by Sarkar et al.[14] They observed a significant difference in intraoperative VASA (P = 0.0001) score of patients subjected to music. However, no significant difference was found in mean SpO2, respiratory rate, pulse rate, SBP, and DBP by them; contrarily, we observed a significant difference in heart rate of patients subjected to spiritual music. In their study, patients were subjected to music using headphones intraoperatively after positioning for surgery; however, in our study, patients were subjected to spiritual music preoperatively. Similarly, the findings of the study conducted by Samsudin et al.[15] supported our study findings. They also observed that patients who were subjected to dzikr listening had lower VASA score (P < 0.001) and mean heart rate (P = 0.013), which was similar to our study findings. However, they subjected one group of patients to Dzikr listening and another group to nature-based sounds, whereas in our study, one group was subjected to spiritual music and another received usual care.

Another study supporting our observation of spiritual music decreasing anxiety was done by Binns-Turner et al.,[16] where music was played perioperatively for patients undergoing mastectomy. They observed a decrease in anxiety (P < 0.001) and mean arterial pressure (P = 0.003). However, we did not observe any significant difference in the average SBP and DBP as observed by them. They allowed patients to choose music of their own choice. It has been observed that studies which reported decrease in mean arterial pressure allowed patients to choose music of their own choice.

Several other studies have also shown that music can reduce anxiety in patients undergoing surgery.[16],[17],[18] For example, effect of music on anxiety was observed by Akihiko Maeyama.[19] They observed that use of music also reduces BIS value during spinal anesthesia (P < 0.01).

Another finding of our study was that patients listening to spiritual music have lower heart rate when compared to the group who did not listen to music. This observation was supported by Bansal et al.,[20] who also observed that use of music lowers mean pulse rate (P < 0.05) in patients undergoing surgery under spinal anesthesia. Their study also supported our finding that music decreases sedative requirement intraoperatively in the music group. They observed that the group subjected to music of their own choice has decreased perioperative sedative requirements (P = 0.02).

Our study found no significant difference between mean SBP and DBP. These observations were different from Syal et al.'s study; the group subjected to music in their study showed a decrease in mean arterial pressure (P < 0.01).[18] However, our observations correlated with their study in terms of decrease in anxiety and mean heart rate. In their study, patients were given alprazolam 0.25 mg on the night before surgery and patients were subjected to music of their choice.

In our study, we observed that playing spiritual music perioperatively decreases sedative requirement intraoperatively. This observation was supported by the findings of Lepage et al.'s[21] study; they observed that listening to music perioperatively can decrease intraoperative sedative requirement (P < 0.05). Nonpremedicated patients were selected for the study and were subjected to music of their own choice. A patient-controlled sedative device was made available to all patients, which was set to deliver 0.25 mg midazolam.

Our study observation, that is, music group requiring lower dose of sedative, was supported by Kulkarni et al.'s[22] study, where they observed that patients who were subjected to music had lower requirements for sedatives midazolam (P = 0.027) and fentanyl (P = 0.05) intraoperatively when compared to patients who did not listen music intraoperatively. They did not observe any significant difference in terms of anxiety, pulse rate, and blood pressure. Contrarily, we observed a significant difference in anxiety level and pulse rate of patients subjected to spiritual music. In our study, patients undergoing surgery under spinal anesthesia were subjected to researcher-selected spiritual music before entering operation theater; however, in their study, patients undergoing interventional radiological procedure were subjected to music of their own choice during procedures. Another study supporting our finding of spiritual music group requires low doses of sedatives intraoperatively is by Sharma et al.[23] where they observed that patients who were subjected to music required lower dose of sedative intraoperatively (P < 0.01) when compared to nonmusic groups. They conducted a study on subjects undergoing elective surgical procedures under regional anesthesia in various departments and preselected music was played during surgery. However, our study subjects were patients undergoing surgery under spinal anesthesia and music of researchers' choice was played.

The study conducted by Rupérez Ruiz et al.[24] did not observed any relation between music application and anxiety, though patients preferred listening to music, but no significant difference was found between both the groups (P = 0.35).

Different forms of music have been used in different studies and most of the time listening to music have helped patients in some or the other way; thus, Siedliecki and Good[25] suggested that no music style is more effective than other at relaxing patient.


   Conclusions Top


Spiritual music can act as a noninvasive, simple, and inexpensive intervention for elderly patients to alleviate perioperative anxiety. It can also reduce the need for sedatives intraoperatively, thereby lowering the risk of side effects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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2.
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Tse MM, Chan MF, Benzie IF. The effect of music therapy on postoperative pain, heart rate, systolic blood pressures and analgesic use following nasal surgery. J Pain Palliat Care Pharmacother 2005;19:21-9.  Back to cited text no. 12
    
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Gift AG. Visual analogue scales: Measurement of subjective phenomena. Nurs Res 1989;38:286-7.  Back to cited text no. 13
    
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Sarkar D, Chakraborty K, Bhadra B, Ghorai TK, Singh R, Mandal U. Effects of music on patients undergoing orthopaedic surgery under spinal anaesthesia: IOSR J Dent Med Sci 2015;14:51-5.  Back to cited text no. 14
    
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Samsudin A, Yahya N, Wan WR, Masdar A, Liu CY, Izaham A. Listening to Islamic Praises (Dzikr) is more effective in reducing perioperative anxiety levels when compared to nature-based sounds in Muslim patients undergoing surgery under regional anaesthesia. IIUM Med J Malaysia 2020;18:10.31436/imjm.v18i3.191.  Back to cited text no. 15
    
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Binns-Turner PG, Wilson LL, Pryor ER, Boyd GL, Prickett CA. Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy. AANA J 2011;79:S21-7.  Back to cited text no. 16
    
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Maeyama A, Kodaka M, Miyao H. Effect of the music-therapy under spinal anesthesia. Masui 2009;58:684-91.  Back to cited text no. 19
    
20.
Bansal P, Kharod U, Patel P, Sanwatsarkar S, Patel H, Kamat H. The effect of music therapy on sedative requirements and haemodynamic parameters in patients under spinal anaesthesia; a prospective study. J Clin Diagn Res 2010;4:2782-7.  Back to cited text no. 20
    
21.
Lepage C, Drolet P, Girard M, Grenier Y, DeGagné R. Music decreases sedative requirements during spinal anesthesia. Anesth Analg 2001;93:912-6.  Back to cited text no. 21
    
22.
Kulkarni S, Johnson PC, Kettles S, Kasthuri RS. Music during interventional radiological procedures, effect on sedation, pain and anxiety: A randomised controlled trial. Br J Radiol 2012;85:1059-63.  Back to cited text no. 22
    
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Sharma V, Domkondwar U. The efficasy of music in lowering intra-operative sedation requirement and recall of intra operative processe. IOSR J Pharm 2012;2:569-78.  Back to cited text no. 23
    
24.
Rupérez Ruiz MP, De San José I, Hermoso Montoya A, Ferreira Valencia T, Gómez Sanz A, López Gutiérrez A. Music therapy and regional anesthesia in orthopedic surgery. Rev Enferm 2014;37:27-30.  Back to cited text no. 24
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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