‘World’s most relaxing song’ is an alternative to sedatives for surgical anxiety, Penn finds

Patients waiting for outpatient orthopedic surgery at Penn Presbyterian Medical Center have a new option to help them relax before their procedures. Instead of taking sedatives routinely used to quell anxiety, they can choose to listen to music specifically designed to be calming.

The new option grew out of a study led by anesthesiologist Veena Graff, who is co-chair of the Penn Presbyterian Pain Committee. It compared three minutes of the song “Weightless” by Marconi Union, with intravenous midazolam, a sedative commonly used before patients received a nerve block. Nerve blocks are delicate procedures that numb regions affected by surgery and can reduce the need for other types of pain control. The team concluded that music was a reasonable alternative to the medicine.

Their study was published this month in the journal Regional Anesthesia & Pain Medicine.

Anxiety before surgery can negatively affect patients by raising stress markers, causing fluctuations in blood flow and worsening recovery. Short-acting sedatives are commonly used to calm people before the nerve block and surgery start, but they can cause breathing and circulation problems and, in 5% to 7% of patients, worse anxiety, Graff said. They also can lengthen recovery time. Plus, a 2016 review of research found only low-quality evidence that midazolam was any better at reducing pre-clinical anxiety than placebo.

The Penn Medicine study did not look at how patients fared after surgery. It asked only about anxiety symptoms while patients were waiting and rated anxiety on a 20- to 80-point scale. The team assigned 157 patients to receive either midazolam or music heard through noise-canceling headphones. Patients with higher anxiety — 50 points and up — were exempted and treated with medication.

The patients in the music group started with an average score of 33.3 compared with 30 for the sedative group. In truth, neither treatment had a huge effect on their scores. The average fell to 30 for the music group and 23.3 for the medication group. The difference in the average change in scores, which took into consideration that some scores went up after the treatment, was not statistically significant. The average improvements in anxiety scores was 1.6 for music and 4.2 for midazolam.

The relatively small change is all the more reason, Graff said, to consider alternatives to the medication. Music is cheap and free of side effects. On the other hand, patients were a little more satisfied with the medication and found it harder to communicate with their doctors while listening to the music. Graff said it may have been a mistake to use noise-canceling headphones and to let patients choose the volume level. Patients might also have been more satisfied if they’d been able to choose the music, she said.

The music also might have worked better, she said, if patients had been able to listen longer, but that would have interrupted work flow.

Graff said doctors should do a better job of asking surgical patients how anxious they are. “Are we perhaps over-treating people with medication when they really don’t need it?” she asked.

She did not know what percentage of Penn Presbyterian patients are currently choosing music over medication. But some, she said, are picking a third option: Nothing.