Music May Lessen Need for Anesthesia During Cataract Surgery, Study Finds

A recent study found that hypertensive events and anesthesia use may be reduced when patients listen to music before cataract surgery, bolstering findings on music therapy from other studies.

In the JAMA Ophthalmology article,¹ researchers in Paris, France, described how a web app–based music intervention could reduce hypertension in patients undergoing cataract surgery.

“Hypertensive events during cataract surgery may induce complications,” the researchers wrote. “Information and communication technologies applied to health are popular, but clinical evidence of its usefulness is rare and limited to treating anxiety without specific analysis.”

In addition, recent articles have described the potential effects of personalized music choices as part of a mobile-based intervention on pain but not on anxiety, they added.

The randomized, single-blinded, controlled clinical trial was composed of 2 arms and took place at Cochin Hospital in Paris, France, in 2018. The researchers screened 313 participants undergoing an elective phacoemulsification procedure for their first cataract under local anesthesia.

Participants requiring cataract surgery were assigned randomly to either the experimental arm (web app–based music listening intervention delivered via headphones) or the control arm (noise-canceling headphones without music). Both arms used the headphones for 20 minutes before surgery.

A total of 310 participants were randomized in the study (155 to each arm) and 309 were analyzed. The mean (SD) age of the participants was 68.9 (10.8) years, and 57% were female.

The researchers found that the incidence of hypertension was significantly lower in the music arm (13.6%) than in the control arm (52.9%), indicating an absolute difference between the 2 arms of 39.3% (95% CI, 21.4-48.9%; P < .001).

In addition, the mean (SD) level of anxiety, measured using a visual analog scale, was lower in the music arm (1.4 [2.0]) than in the control arm (3.1 [2.4]), with a difference of 1.5. The mean (SD) number of sedative drug injections required during surgery was 0.04 (0.24) vs 0.54 (0.74) in the music vs control arms, respectively.

The study offers evidence that a patient-controlled music intervention may ameliorate the consequences of anxiety on cataract surgery.

“By reducing hypertension, levels of anxiety, and the need for sedative drugs during the procedure, a 20-minute music intervention before cataract surgery based on the U sequence algorithm appears to offer an effective treatment for anxiety, thus highlighting the importance of listening to music in decreasing its debilitating effects,” the researchers wrote.

In addition, the treatment is easily accessible and distributable via its computer- and smartphone-based app.

“Overall, we would like to stress the positive effects of using a web app–based music intervention as potential large-scale treatment for those who experience anxiety and possibly in the context of other types of surgical procedures,” the authors concluded.

There are numerous other studies on music’s effect on patients’ anxiety levels before surgery.

In a Journal of Clinical Oncology article,² for example, researchers found that including music therapy as a complementary modality with breast cancer surgery may “help manage preoperative anxiety in a way that is safe, effective, time-efficient, and enjoyable,” they wrote.

In that study, 207 female patients undergoing surgery for potential or known breast cancer were randomly assigned to receive either patient-selected live music (LM) preoperatively with therapist-selected recorded music intraoperatively, patient-selected recorded music (RM) preoperatively with therapist-selected recorded music intraoperatively, or usual care (UC) preoperatively with noise-blocking earmuffs intraoperatively.

The LM and the RM groups did not differ significantly from the UC group in the amount of propofol required to reach moderate sedation. However, both the LM and the RM groups had greater reductions in anxiety scores preoperatively compared with the UC group (mean [SD] changes: −30.9 [36.3], −26.8 [29.3], and 0.0 [22.7], respectively).

The LM and RM groups did not differ from the UC group with respect to recovery time, but the LM group had a shorter recovery time compared with the RM group (a difference of 12.4 minutes).

References

1. Guerrier G, Abdoul H, Jilet L, Rothschild PR, Baillard C. Efficacy of a web app–based music intervention during cataract surgery: a randomized clinical trial. JAMA Ophthalmol. 2021;139(9):1007-1013. doi:10.1001/jamaophthalmol.2021.2767

2. Bradley JB, Lane D, Mayo D, Schluchter M, Leeming R. Effects of music therapy on anesthesia requirements and anxiety in women undergoing ambulatory breast surgery for cancer diagnosis and treatment: a randomized controlled trial. J Clin Oncol. 2015;33(28):3162-3168. doi:10.1200/JCO.2014.59.6049