Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy

doi:10.1016/S0090-4295(02)02375-0

Urology

Volume 61, Issue 2, February 2003, Pages 282-286

https://doi.org/10.1016/S0090-4295(02)02375-0 Get rights and content

Abstract

Objectives

To evaluate the efficacy of music on sedation in extracorporeal shock wave lithotripsy (ESWL) treatment to compare its anxiolytic effects with those of midazolam.

Methods

Ninety-eight urolithiasis patients were randomly divided into two groups. Hemodynamic parameters, including mean arterial pressure, heart rate, respiration rate, and oxygen saturation, were recorded in all patients. In 50 patients (group 1), 2 mg of midazolam was administered intravenously 5 minutes before ESWL. In group 2 (n = 48), music chosen by the patients was listened to with a headset and continued during the treatment. The visual analog scale (0 to 100 mm), Observer’s Assessment of Alertness/Sedation Scale, State and Trait Anxiety Inventory-Trait Anxiety test, and State and Trait Anxiety Inventory-State Anxiety test were administered for the evaluation of pain, sedation level, and patient anxiety.

Results

For the hemodynamic parameters, a statistically significant decrease in mean arterial pressure was noted at the end of the ESWL procedure in group 2 and in oxygen saturation from the 10th minute to the end of the treatment in group 1. Although the visual analog scale, Observer’s Assessment of Alertness/Sedation Scale, and State and Trait Anxiety Inventory-State Anxiety test did not show statistically significant differences, the State and Trait Anxiety Inventory-Trait Anxiety score was found to be lower in the music group (group 2) than in the midazolam group (group 1).

Conclusions

With the anxiolytic effects of music, ESWL can be performed more effectively with the patient in a comfortable state. Listening to music by patients during the ESWL session is a feasible and convenient alternative to sedatives and anxiolytics.

Section snippets

Material and methods

Ninety-eight patients, between the ages of 19 and 68 years, with urolithiasis in American Society of Anesthesiologist class I-II physical status were enrolled in the study. All patients had only one urinary tract stone, and none of them had undergone ESWL treatment before. ESWL treatment was performed with a third-generation electrohydraulic StoneLitho3pter (PCK), and all patients underwent one session of ESWL.

We applied 15 g of EMLA cream (eutectic mixture of local anesthetics) to the skin of

Results

No statistically significant difference was found between the two groups according to patient age, weight, height, and ESWL parameters (stone size, voltage, and shock number). The ESWL duration and fentanyl requirement were significantly lower statistically in the music group (TABLE I, TABLE II).

In the hemodynamic measurements, the decrease in mean arterial pressure at the end of the ESWL procedure was statistically significant in group 2 (group 1, 97.2 mm Hg versus group 2, 90.9 mm Hg, P =

Comment

A clear level of stress has been observed in ambulatory surgical procedures and is caused by different factors. The preoperative anxiety level is connected to the patient’s tolerability of stress and fear of surgery.2 When sedation-analgesia procedures are used and the patient is awake during the procedure, pain sensation, staying still in the same position for a long time, being in a different condition, and discomfort from visual and auditory stimuli increase the stress and anxiety of the

Conclusions

Effective sedation can be reached with music as appropriately as with sedative agents. In our study, music was as effective as midazolam with regard to its sedative and anxiolytic properties. It can also be justified because its use will avoid respiratory depression and other vital changes that can occur with pharmacologic agents, and it will allow rapid patient recovery. With the anxiolytic effects of music, the ESWL procedure can be performed more effectively with the patient in a comfortable

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Anxiety is a prevalent mental health issue that affects both individuals and society. Music therapy has been found effective in reducing anxiety in clinical trials. However, the available music pieces for therapy are limited and may not meet the requirements of individuals from diverse backgrounds. To overcome this limitation, we propose a novel model called the spatio-temporal therapeutic music transfer model (StTMTM) for anxiety reduction. The StTMTM can transfer a piece of music to a new therapeutic music piece that satisfies both the criteria for music therapy and the requirements of individuals. Our approach involves first developing a music feature extraction network that can extract spatio-temporal music features. We then train the network on different genres and transfer the learning results from genre classification to music transfer for anxiety reduction. We also propose a deep learning-based music transfer network with melody and accompaniment encoders and a newly designed loss function to modify a piece of music to be therapeutic. Experimental results on 92 subjects demonstrate that the transferred therapeutic music produced by the StTMTM exhibits exceptional performance in anxiety reduction. Overall, our model has the potential to make music therapy more accessible and effective for individuals with diverse backgrounds and needs.
Effect of music on postoperative recovery quality: A narrative review
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Postoperative recovery is a multipronged process of reclaiming the preoperative autonomy or dependency in daily life activities, resuming control over the physical, psychological, and social state while returning to the ideal state described by relative standards. Both pharmacological and nonpharmacological interventions are applied to improve the overall quality of recovery.
Using the Medical Subject Headings (MeSH) method, we gathered articles from 1997 to 2020 from PubMed, Cochrane, and Google Scholar. A total of 22 articles were selected based on all the inclusion and exclusion criteria, and they were evaluated.
Even though the mode of action of music has not been clearly understood, music intervention (MI) is one of the few nonpharmacological interventions applied in clinical settings to alleviate postoperative pain, anxiety, and stress. Multiple studies have shown the relationship between music and its effectiveness on postoperative recovery, although there remains to be incongruity among the results of these studies. This review explored the relationship between music intervention and various aspects and phases of postoperative recovery in terms of postoperative anxiety, pain, anxiolytic requirement, haemodynamics, and postoperative nausea and vomiting (PONV).
The results consistently demonstrate the beneficial effects of music on these aspects during the postoperative period. Additionally, it examines the possible mechanism of action of music intervention. It suggests a direction for future clinicians and researchers to map out the potentially significant benefits of nonpharmacological intervention for optimal postoperative recovery.
Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy – A randomised controlled trial
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Citation Excerpt :
Pain is a subjective experience, making the quantification of pain and the standardisation of patients’ experiences difficult. Multiple therapeutic interventions have been suggested to improve the tolerability of SWL including pharmacological analgesia,7 music,8 audio-visual distraction,9 acupuncture,10 transcutaneous electrical nerve stimulation11 and intracutaneous water.12 Pharmacological agents for pain management are plentiful and well-studied.
We aim to assess if distraction techniques improve patient comfort tolerability of SWL.
We carried out a prospective randomised controlled trial of SWL-naïve patients attending for treatment. Patients were randomised into three groups and offered oral analgesia as standard of care. Group 1 (n = 19) received stress balls to squeeze during treatment. Group 2 (n = 19) listened to music during treatment. Group 3 (n = 17) received standard of care only. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue scale (VAS) after treatment. Primary outcomes were completion of SWL treatment and pain score results.
55 patients attending for SWL were randomised. There was no difference in stone size or position, presence of a stent, height or weight between the groups. VAS scores were lower in controls compared to Group 1 (1.93 vs 3.69, p = 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were lower in controls compared to Group 1 (2.58 vs 4.77, p = 0.06). VAS scores were lower in patients who received optional analgesia alone than in patients who received stress balls alone (1.92 vs 4.07, p = 0.05). Across all subgroups, pain scores were lower in the control group compared to the distraction groups, but did not achieve significance.
In conclusion, distraction techniques should not replace standard of care for analgesia during SWL.
This study was registered with clinicaltrials.gov (identifier NCT03379922).
Role of Complementary Medicine (Music, Acupuncture, Acupressure, TENS and Audio-Visual Distraction) in Shockwave Lithotripsy (SWL): A Systematic Review From EAU Sections of Urolithiasis (EULIS) and Uro-Technology (ESUT)
2020, Urology
We performed a systematic review to look at the role of alternative or complementary medicine such as music, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS) and audiovisual distractions to decrease analgesia requirement and alleviate anxiety during SWL. Twenty-three papers(2439 participants) were included: Music (n = 1056.6%), Acupuncture (n = 517.7%), Acupressure (n = 13.8%), TENS (n = 617.2%), and audiovisual distraction (n = 14.6%). Most of the studies showed that complementary therapy, lowered pain, and anxiety with higher patient satisfaction and willingness to undergo the procedure. With its feasibility and convenience, urological guidelines need to endorse it, and more should be done to promote its use in outpatient urological procedures.
Comparison of Two Different Distraction Methods Affecting the Level of Pain and Anxiety during Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial
2018, Pain Management Nursing
Citation Excerpt :
The scale is considered to be a reliable, valid, and feasible measurement tool in repetitive measures. This scale has been used to measure pain intensity during ESWL in many studies (Ozsaker & Diramali, 2014; Resim, Gumusalan, Ekerbicer, Sahin, & Sahinkanat, 2005; Yilmaz et al., 2003). The scale has been used in research with adults (Williamson & Hoggart, 2005).
Background: Extracorporeal shock wave lithotripsy can cause pain and anxiety for patients. Despite the use of many distraction methods to reduce pain and anxiety, there is no study on the use of stress balls during lithotripsy. Aim: The aim of the study was to investigate the efficacy of use of stress balls and music therapy to reduce pain and anxiety during lithotripsy. Design: This was a single-center, parallel randomized controlled trial. Settings: The study involved the lithotripsy unit in a training and research hospital in Turkey. Participants: The study included 120 patients who had kidney or ureter stones. Methods: The patients were randomly divided into three groups. The control group (group 1) received no interference, whereas experimental groups received stress ball (group 2) and music (group 3) interventions during lithotripsy, respectively. Data were collected using the Patient Information Form, visual analog scale, and State-Trait Anxiety Inventory. Results: There was no statistically significant difference among the three groups in regard to anxiety and pain mean scores (p > .05). No statistically significant difference was found between anxiety scores before and after lithotripsy in each group (p > .05), whereas there was a statistically significant difference between pain scores during and after lithotripsy (p < .05). Conclusion: Based on the present study, no statistically significant difference was found between the use of stress balls and music in reducing pain and anxiety during lithotripsy. Further studies are needed to evaluate the effectiveness of stress balls used during lithotripsy.
Effect of Music on Outpatient Urological Procedures: A Systematic Review and Meta-Analysis from the European Association of Urology Section of Uro-Technology
2018, Journal of Urology
Music is a practical, inexpensive and harmless analgesic and anxiolytic. An increasing number of original studies have been performed to investigate its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures.
We systematically reviewed the effect of using music during all reported outpatient urology procedures, including transrectal ultrasound guided prostate biopsy, shock wave lithotripsy, urodynamic studies, percutaneous nephrostomy tube placement and cystoscopy. Data were included on all randomized trials from 1980 to 2017 and no language restrictions were applied.
Included in analysis were 16 randomized studies in which 972 of 1,950 patients (49.8%) were exposed to music during an outpatient procedure. The procedures included transrectal ultrasound guided prostate biopsy in 4 studies in a total of 286 patients, shock wave lithotripsy in 6 studies in a total of 1,023, cystoscopy in 3 studies in a total of 331, urodynamics in 2 studies in a total of 210 and percutaneous nephrostomy in 1 study in a total of 100. All studies incorporated a visual analog score to measure pain. Anxiety was measured by STAI (State-Trait Anxiety Inventory) in 13 studies and by a visual analog scale in 2. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14. When using music, overall procedural satisfaction was better in 9 studies and patient willingness to repeat the procedure was also higher in 7. Our meta-analysis revealed a significant reduction in visual analog scale and STAI findings across all studies (p <0.001).
Our systematic review demonstrated a beneficial effect of music on urological outpatient procedures. Music seemed to decrease anxiety and pain. It might serve as a useful adjunct to increase procedural satisfaction and patient willingness to undergo the procedure again.

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Rapid communicationMusic decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Comment

Conclusions

Soc Sci Med

Int J Nurs Stud

J Pain Symptom Manag

Ann Emerg Med

Factors determining analgesic and sedative drug requirements during extracorporeal shock wave lithotripsy

Urol Int

Peri-operative anxiety in patients undergoing extracorporeal piezolithotripsy

J Adv Nurs

Music research in medical/dental treatmentmeta-analysis and clinical applications

J Music Ther

Rapid communication
Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy