Effects of Intraoperative Auditory Stimulation on Pain and Agitation on Awakening After Pediatric Adenotonsillectomy

Abstract

IMPORTANCE Severe pain on awakening (POA) and emergence delirium (ED) are common following pediatric adenotonsillectomy. Effective preventive interventions are lacking. OBJECTIVE To determine the effects of intraoperative auditory stimulation on reduction of POA and ED after pediatric adenotonsillectomy. DESIGN, SETTING, AND PARTICIPANTS Single-center, double-blinded, 4-armed, randomized clinical trial of children undergoing adenotonsillectomy from March 2018 to May 2019 at a tertiary care pediatric referral center.INTERVENTIONS Children were randomized to 1 of the following groups: auditory stimulation with music, auditory stimulation with noise, ambient noise insulation with masking earplugs, and a control group receiving no intervention. Ear inserts were placed in the operating room once general anesthesia was administered. Stimulation parameters were based on the preoperative audiological evaluation and the appropriate fitting of the transduction system, including ambient noise level monitoring. MAIN OUTCOMES AND MEASURESThe primary outcome was POA levels measured on 10-point scales according to age-appropriate validated tools. The secondary outcome was ED levels assessed according to the Pediatric Anesthesia Emergence Delirium 20-point scale.RESULTS A total of 104 consecutive healthy children (median [interquartile range] age at surgery, 5.0 [3.8-6.4] years) were included in the analysis. Music had a large effect size on POA (0.63; 98% CI, 0.43-0.84) and a medium effect size on ED (0.47; 98% CI, 0.21-0.75), while noise had a medium effect size on POA (0.47; 98% CI, 0.22-0.73) and a large effect size on ED (0.63; 98% CI, 0.44-0.85) compared with controls. The earplugs group showed a small effect size on POA and ED. Considering a clinically meaningful threshold of greater than 4 for POA and 10 or greater for ED at dichotomized analysis, a large effect size was achieved by music (1.39; odds ratio [OR], 0.08; 98% CI, 0.02-0.29; and 0.84; OR, 0.22; 98% CI, 0.06-0.75, respectively) and noise (0.97; OR, 0.17; 98% CI, 0.05-0.6; and 1.48; OR, 0.07; 98% CI, 0.02-0.26, respectively), while earplugs resulted in a small effect size. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, children undergoing adenotonsillectomy who received intraoperative auditory stimulation demonstrated a clinically meaningful decrease in POA and ED in the immediate postoperative period. Further research is needed to assess whether intraoperative auditory stimulation may decrease POA and ED in children undergoing other types of surgical procedures.

Music Intervention for Pain Control in the Pediatric Population: A Systematic Review and Meta-Analysis

“…A total of 5601 participants in 38 articles, published between 2006 and 2022, were included (Table 1). Among all articles, eight articles were conducted in America [31][32][33][34][35][36][37], 14 in Europe [38][39][40][41][42][43][44][45][46][47][48][49][50][51], 13 in Asia [52][53][54][55][56][57][58][59][60][61][62][63][64][65], and three in Africa [11,66,67]. Most studies (n = 33) had a parallel randomized controlled design, and five studies [39,45,48,53,62] had a cross-over randomized controlled design.…”

“…The mean age of the participants ranged from a few days of birth to teenage years. To be specific, two articles included adolescents [43,52], 12 newborns [31,39,41,48,49,53,56,[60][61][62]64,65], and 24 infants and children [11,[32][33][34][35][36][37][38]42,[44][45][46][47]50,51,54,55,[57][58][59]63,66,67]. On the other hand, 29 studies were conducted in the hospital setting [11,[32][33][34]36,[38][39][40][41][44][45][46][47]…”

“…On the other hand, 29 studies were conducted in the hospital setting [11,[32][33][34]36,[38][39][40][41][44][45][46][47][48][49][50][51][53][54][55][56][58][59][60][61][62][64][65][66][67], and 9 in the clinic setting [31,35,37,42,43,51,52,57,63]. As for the type of pain, 18 articles examined participants with prick pain (heel lance, intravenous (IV) insertion, immunization, acupuncture, and lumbar puncture) [33,35,37,39,41,43,48,51,53,54,56,…”

“…As for the type of pain, 18 articles examined participants with prick pain (heel lance, intravenous (IV) insertion, immunization, acupuncture, and lumbar puncture) [33,35,37,39,41,43,48,51,53,54,56,[58][59][60][62][63][64][65], 8 participants with procedural pain (emergency procedural, retinopathy of prematurity (ROP), wound care, peripherally inserted central catheter (PICC), orthodontic procedure, and continuous positive airway pressure (C-PAP)) [11,31,32,49,50,52,61,67], 4 participants with chronic pain (rehabilitation, illness pressure) [42,45,57,66], and 8 participants with postoperative pain [34,36,38,40,44,46,47,55]. Among all 38 studies, the participants listened to classical music in 11 articles [32,34,[39][40][41][42]44,46,…”

“…Additionally, in one article [53], two groups of participants listened to either kids' music or world music, and thus this article was separated into two datasets. As for the listening instruments, 9 articles used headphones [32,[34][35][36]38,44,53,63,65], 4 used earphones [46,54,55,59], 19 used speakers [11,31,33,[39][40][41][42][47][48][49]51,56,58,[60][61][62]64,66], and 4 used live performance [37,45,50,67]. In one article [43], participants listened to music using either headphones or speakers, and thus this study was separated into two datasets.…”