Palmer, J.B., Lane, D., Mayo, D., Schluchter, M., & Leeming, R. (2015). Effects of music therapy on anesthesia requirements and anxiety in women undergoing ambulatory breast surgery for cancer diagnosis and treatment: A randomized controlled trial. Journal of Clinical Oncology, 33, 3162–3168.

To determine if a decrease in the amount of anesthesia and a decrease in recovery time would occur in either of the treatment groups receiving music therapy compared to the usual care or control group.

Patients who met inclusion criteria were randomly assigned to a five-minute intervention or usual care in one of three groups: patient-selected live music (LM) with therapist-selected recorded music during the operative procedure; patient-selected recorded music (RM) preoperatively with therapist-selected recorded music during the operative procedure; or usual care (UC) preoperatively with noise-blocking earmuffs during the surgical procedure.

• N = 207 (LM = 69, RM = 70, UC = 68) 
• AGE: Range = 18-94 years
• FEMALES:  100 %
• KEY DISEASE CHARACTERISTICS: Breast cancer or suspected breast cancer biopsy, lumpectomy, and re-excision
• OTHER KEY SAMPLE CHARACTERISTICS: English-speaking women undergoing known or suspected breast cancer surgery; aged 18-years or older; ASA classification I–III; all were given fentanyl 1 mcg/kg and versed 0.02 mg/kg followed by adherence of a monitor sensor to the forehead and a propofol drip. 

• SITE: Multi-site    
• SETTING TYPE: Outpatient    
• LOCATION: University Hospitals Case Medical Center in Cleveland, OH; University Hospitals Richmond Medical Center in Richmond Heights, OH

• PHASE OF CARE: Diagnostic

• Randomized, controlled trial using three groups

• Global Anxiety-Visual Analog Scale (GA-VAS): before and after the five-minute music intervention or control condition
• Bispectral Index (BIS) monitor sensor: an intraoperative measure of sedative effects on the brain corresponding to alertness (goal of BIS 70 was target for recording amount of propofol administered)
• Recovery time: the interval between the end of surgery and the time the recovery nurse determined that d/c criteria was met
• Patient satisfaction: five-item questionnaire administered before discharge with questions based on the CAHPS Surgical Care Survey of the Consumer Assessment of Health Providers and Systems (CHAPS) program

No significant baseline differences in the three groups nor in amount of propofol used to achieve sedation level of BIS 70. Intervention groups showed significantly decreased levels of anxiety compared to control group; no significant difference in changes between the two groups were noted. Greater changes in anxiety level were seen when baseline anxiety scores were high: (i.e., the higher the pretreatment anxiety, the greater the change [reduced anxiety] in anxiety level after treatment). The amount of change (slope) in the LM group and RM groups were not different from each other, but were different from the amount of change (slope) in the control group. Recovery time, or time to discharge readiness determined by the recovery nurse, was not different for the intervention groups compared to the control group, but was shorter in the LM group compared to the RM group. Patient satisfaction scores revealed no differences among the three groups.

Noise-blocking earmuffs and music therapy were not found to reduce the amount of anesthesia required as measured by the BIS monitor. Satisfaction scores were high with and without music therapy. Music therapy was found to reduce anxiety more when initial anxiety scores were high.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Other limitations/explanation: Blinding was not possible in busy preoperative or operative setting. Completing a questionnaire about anxiety may stimulate anxious thoughts. There were no attentional control as usual care in preoperative setting involves caring personnel. The BIS monitor may not provide the sensitivity for measuring changes based on music therapy in these types of patients undergoing these types of operative procedures.

Patients felt cared for and cared about with or without music therapy; anxiety levels were lowered with either type of music therapy when baseline anxiety levels scored high. Nurses may conduct anxiety screening and offer music therapy to reduce anxiety scores as part of the usual care environment.