Noise-Canceling Headphones and Music Decrease Intraoperative Patient Anxiety During Wide-Awake Hand Surgery: A Randomized Controlled Trial

Abstract

Wide-awake local anesthesia no-tourniquet (WALANT) hand surgery has gained popularity because of its cost savings, safety, favorable outcomes, and high patient satisfaction. However, the wideawake nature of the technique causes many patients to experience anxiety during the procedure. Nonorthopedic studies have reported the anxiolytic effects of intraprocedural music in a variety of wideawake medical procedures. This prospective randomized controlled trial investigated the effects of wearing noise-canceling headphones and listening to music on patient anxiety during WALANT hand surgery. Methods: Institutional review board approval was obtained. Patients were randomized to one of the following groups: (1) a headphones group that wore noise-canceling headphones and listened to music (genre of their choice) during the surgery, or (2) a control group that neither wore noise-canceling headphones nor listened to music during surgery. Patient anxiety was assessed on a 10-point visual analog scale before, during, and after surgery. All patients completed an overall experience questionnaire after surgery. Results: Fifty patients were enrolled, with 25 in each group. Both the groups were similar in terms of patient characteristics, diagnosed anxiety, and preoperative level of anxiety. The headphones group was found to have significantly less intraoperative anxiety (1.02 vs 2.32, respectively; P ¼ .017) and a significantly greater net decrease in anxiety from the preoperative to intraoperative level (À1.78 vs À0.56, respectively; P ¼ .033) than the control group. In the headphones group, 92% (23/25) of patients stated that they would recommend wearing noise-canceling headphones and listening to music to other WALANT hand surgery patients. All (50/50) patients in both groups reported that they would choose to undergo WALANT hand surgery again if needed for the same problem. Conclusions: The use of noise-canceling headphones with music during WALANT hand surgery significantly decreases intraoperative patient anxiety. This intervention represents an effective, safe, and inexpensive nonpharmacologic measure to improve patient anxiety and overall experience with WALANT hand surgery. Type of study/level of evidence: Therapeutic I.

The Role of Music-Based Interventions in Orthopaedic Surgery

“…A study done by Kukreja et al investigated total knee arthroplasty patients with spinal anaesthesia and found that the postoperative State-Trait Anxiety Inventory (STAI) Trait score was significantly reduced when music was played during the surgery (p=0.011) [20]. A similar 2021 study by Townsend et al on the efficacy of MBI via headphones during wide-awake local anaesthetic no-tourniquet hand surgeries demonstrated lowered intraoperative anxiety [29]. These studies lay a foundation for the applicability of MBI intraoperatively and contribute to the already existing literature about intraprocedural MBI.…”

“…Most commonly, MBI is administered during the recovery phase following surgery [7,[16][17][18][19][21][22][25][26][27]31]. MBI has also been administered intraoperatively for patients undergoing surgeries either wide-awake under local anaesthesia or with spinal anaesthesia and has been associated with increased patient satisfaction scores (p=0.009) and reduced anxiety (p=0.017) post-operatively [20,29]. The methods of MBI vary widely as well, ranging from patients listening to music on their own [16][17][18][20][21][22][23][25][26][27]31], music being played ambiently [20], or official clinical visits by music therapists [19].…”

“…The genre of music administered in these sessions is also diverse: from popular music to traditional folk music [20,23]. Finally, MBI has been administered for patients undergoing a variety of procedures across orthopaedic subspecialties including adult reconstruction [16][17][18][19][21][22][23][24][25], foot and ankle [26][27]31], hand [29], shoulder and elbow [19], spine [23], and trauma [18,21,31].…”

“…A similar trend has been found regarding the reduction of negative psychological outcomes in the postoperative period. Psychological outcomes were assessed using anxiety NRSs [19], the State-Trait Anxiety Inventory (STAI) [20,23,29], and VAS for anxiety [16,23,29,32] (Table 1). Various incongruities exist in the measures of pain and anxiety as well as the method of administration of MBI in these studies.…”

“…Studies have also characterized the utility of MBI for other outcomes following orthopaedic surgery, such as delirium and confusion [17,25], opioid use [16,20,22], and patient satisfaction [16,20,29]. An early study by McCaffrey and Locsin on delirium and confusion showed a decrease in episodes of delirium and confusion in patients with MBI following orthopaedic surgery (p=0.001) [25].…”