Music, soft voices during surgery may reduce postoperative opioid use

Playing recordings of soft music or soothing words through earphones when patients are under general anesthesia could help them reduce the need for opioids after surgery, according to a study published in BMJ.

“Anesthesia is usually considered a state of no sensations, yet several observations suggest that the central auditory pathway stays intact during anesthesia,” Hartmuth Nowak, Dr. Med, senior physician in the department of anesthesiology, intensive care medicine and pain therapy at University Hospital Knappschaftskrankenhaus and Ruhr University Bochum in Germany, and colleagues wrote. “Intraoperative awareness, for instance, has been reported in a small number of patients and can lead to severe sequelae, such as post-traumatic stress disorder.”

Nowak and colleagues conducted a blinded, randomized, placebo-controlled trial of adults aged 18 to 70 years who underwent elective surgery at five hospitals in Germany.

The patients randomly assigned to the intervention (n = 191) were given an audiotape of background music and positive connotations — which included topics like the competence of the medical team, regulating pain, dissociation to a safe location, confidence and anxiety control — for 20 minutes, followed by 10 minutes of silence. Participants’ tapes were played throughout the surgery. When anesthesia was stopped at the end of their surgery, a new tape was played to prepare them to emerge from anesthesia. The medical team stopped the tape and removed participants’ earphones prior to extubating.

Participants assigned to the control group (n = 194) received an audiotape with no sound. Neither patients nor the medical staff knew which group the patient was assigned to.

The researchers found that patients in the intervention group needed significantly lower opioid doses within 1 day of surgery, with a median of 4.0 mg of morphine equivalents compared with 5.3 mg morphine equivalents in the control group (effect size = 0.36; 95% CI, 0.16 to 0.56).

The intervention group also had fewer participants who required opioids after surgery, with just 63% of participants in the group needing opioids compared with 80% of those in the control group.

Nowak and colleagues also observed lower pain scores consistently and significantly in the intervention group in the day after surgery, with an average score reduction of 25%.

“With a saving of one-third of postoperative opioids and noticeably fewer patients using opioids, the observed effect of the tested non-drug intervention not only reached statistical significance but is also of clinical interest,” Nowak and colleagues wrote.

They said additional studies could lead to calls for the use of therapeutic suggestions more regularly in surgeries.

“The efficacy of intraoperative therapeutic suggestions shown here, together with the low effort and costs necessary for implementation and with no side effects observed or expected, makes it hard to argue against using this simple method for reduction of postoperative pain and opioid use,” they added.