Music Therapy Pathway in Patients Undergoing Total Laparoscopic Hysterectomy
Condition: Anxiety; Pain, Postoperative
MeSH terms: Pain, Postoperative; Anxiety Disorders
Study type: Interventional

Summary: 
      Music therapy is a non-invasive, safe, and inexpensive intervention that can be easily and
      successfully delivered. it has been shown that music therapy might reduce the postoperative
      pain in patients undergoing cesarean section and in those with cancer, showing a lower state
      of anxiety and greater pain reduction in participants who received music interventions.

      The aim of the present study is to investigate the role of music and music therapy on anxiety
      and perception of pain in patients undergoing elective hysterectomy for benign disease.
    

Detailed description: 
      Hysterectomy is the second most common surgical procedure in the United States. Uterine
      fibroids (with or without the association of heavy menstrual bleeding) represent the primary
      indication for surgery. Prospective controlled trials have shown that the laparoscopic
      approach guarantees benefits in terms of perioperative surgical outcomes and better patients'
      quality of life if compared with open surgery. Music is a non-invasive, safe, and inexpensive
      intervention that can be delivered easily and successfully. Results of a recent meta-analysis
      of 73 RCTs demonstrated that music could be offered as a way to help patients reducing pain
      and anxiety during the postoperative period. Recently a prospective randomized trial
      demonstrated a reduction of anxiety also in patients undergoing gynecological minor
      procedures (office hysteroscopy). Thanks to the use of a validated scale for assessing the
      preoperative and postoperative level of anxiety (STAI: State-Trait Anxiety Inventory), an
      Italian group demonstrated an average reduction of approximately 5 points of STAI score in
      patients enrolled for listening to music before surgery compared to the control group
      (without music). Similarly, a RCT demonstrated that preoperative music intervention might
      also reduce the postoperative pain in patients undergoing cesarean section (reduction of 1.35
      VAS points at 6 hours). A recent meta-analysis evaluated music interventions for improving
      psychological and physical outcomes in adult and pediatric patients with cancer, showing a
      lower state of anxiety and greater pain reduction in participants who received music
      interventions.

      No study has been performed that aimed to investigate the role of music on anxiety and
      perception of pain in patients undergoing elective hysterectomy for benign disease, up to
      now.

      A comparison with a superiority trial is required to evaluate the effects of music played
      preoperatively in women undergoing total laparoscopic hysterectomy for benign disease. Our
      findings will offer evidence in favor of the use of music therapy as a method to reduce
      perioperative anxiety and postoperative pain.
    

Intervention name(s): Music therapy; Control
Intervention type(s): Other; Other
Intervention description(s): On the surgery day, the patient is accompanied by music-therapist all the way from her room to the operating theatre in order to monitor and adapt music-therapy intervention.
The patient, prior to the anesthetic, take faces 3 phases of music therapy intervention (1 hour):
1° Phase Active Music therapy: the patient takes part in a session of live improvisational music therapy, with the therapist, to elaborate pre-operative stress.
2° Phase Relaxation with Receptive Live Music: music therapist play live to relax patients with autogenic training and tunnings breathing.
3° Phase playlist listening based on the patient's needs. Patients listen to music with an mp3 player with earphones within the ear canal (H&H CE mp3/Usb; Headphones on Air in-ear with volume control) with a maximum volume of 60 dB (previously set with a sound level meter).; Standard perioperative management including perioperative care (without the use of music / music therapy)
Other intervention name(s): Music; Standard management
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Hysterectomy; Music therapy; Laparoscopy; Anxiety; Stress; Pain; Minimally invasive surgery; TLH