Music Interventions in Pediatric Surgery (The Music Under Surgery In Children Study): A Randomized Clinical Trial

Abstract

BACKGROUND: Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery. METHODS: The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children’s hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0–3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (www.trialregister.nl). RESULTS: One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3–11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, −1.22; 95% CI, 2.60–0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069). CONCLUSIONS: Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.

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]…”

Implementation of music in the perioperative standard care of colorectal surgery: study protocol of the IMPROVE Study

“…15 16 Recent systematic reviews of randomised controlled trials have shown significant positive effects on listening of recorded music interventions on preoperative anxiety, postoperative pain, intraoperative sedative and postoperative analgesic medication requirement, as well as postoperative neurohormonal stress reaction. [17][18][19] Pharmacological agents, such as benzodiazepines and opioids, are widely used as treatment for anxiety and pain, even though the side effects and risks are well known. [20][21][22][23][24] Preoperative benzodiazepines to reduce anxiety have been associated with worse postoperative recovery and higher risk for delirium.…”

Musicoterapia Hospitalaria: Impacto del rock and roll en la unidad pediátrica de trasplantes del Hospital Universitario La Paz

“…Este desarrollo se está produciendo tanto por los proyectos de atención directa, como por las evidencias publicadas sobre los beneficios propiciados en los pacientes pertenecientes a dicho ámbito. Artículos de referencia ponen de manifiesto la efectividad de esta disciplina en cuestiones como la reducción de apneas en el prematuro (Fernández, 2015), la reducción del estrés hospitalario (Dos santos y Sinegaglia, 2018; Russ et al, 2020), en la influencia de la música en casos de cáncer (Nardone et al, 2020), en su función en las cirugías pediátricas (Kühlmann et al, 2020) o en los beneficios en bebés prematuros y sus padres (Yakobson, 2020), entre otros.…”