Could Music be an Alternative to Sedation in Patients Treated Total Knee Arthroplasty With Regional Anesthesia?: A Randomized Clinical Trial

1. Introduction Patients generally experience high levels of anxiety when are hospitalized to undergo surgery and other invasive procedures. Anxiety is an emotional state or condition characterized by stress and unpleasant feelings. Awake patients in the operating theatre are afraid of they will feel pain during the surgical and/or regional anaesthetic procedures, which contributes to increased anxiety. Patients operated under regional anaesthesia are in particular need of sedation during the perioperative period. The purpose of the sedation is to ensure comfort, full cooperation and cardiovascular stability of patients who can maintain a patent airway. However, because of the adverse effects (respiratory depression, nausea, vomiting), optimal patient satisfaction is hard to achieve. Additionally, intraoperative anxiety is often associated with a greater incidence of pain after surgery.

On the other hand, toxicity of general anaesthetics has been recently studied from its neurotoxic effect to neuroapoptosis. In some cases, they may cause postoperative cognitive dysfunction, and other side effects known as hypoxemia, respiratory depression and increased morbidity and mortality.

Music has been suggested as a potential intervention to reduce anxiety and pain in the operating room environment. Systematic meta-analysis conducted by Nilsson revealed that 50% of studies (12 of 24) published between January 1995-January 2007 found significant reductions in anxiety scores as measured by STAI. and then more studies have been carried out on the benefits of music, which have continued to show that music reduces preoperative and postoperative anxiety and also reduces postoperative pain.

There are also studies that conclude that patients to listening music require less midazolam to achieve a similar degree of relaxation as controls in ambulatory surgery patients and that the relaxing music a useful alternative to midazolam for pre-medication before surgery.

Music holds considerable promise as an adjuvant pain management therapy and in mild cases may be used to supplement, perhaps even replace, pharmaceutical interventions before, during, and after painful procedures. The maximal reduction in pain intensity levels is 0.9 units on a zero to ten scale; although this difference reaches statistical significance, its clinical importance is unclear.