Investigation of the Effects of Music on Anxiety During Operations Under Spinal Anaesthesia at an Hospital in Cambodia

Investigation of the Effects of Music on Anxiety During Operations Under Spinal Anaesthesia at an Hospital in Cambodia

A Prospective Randomised Controlled Trial to Investigate the Effects of Intra-operative Music on Anxiety Levels During Procedures Under Spinal Anaesthesia at a Surgical Centre in Cambodia

This study investigates he effects of intra-operative music on anxiety levels during procedures under spinal anaesthesia at a surgical centre in Cambodia. Participants will be randomly allocated to either the music (M) group or the 'control' (C) group. The M group will receive music played through headphones for the duration of the operation. The C group will receive no music or headphones. Anxiety will be measured in both groups, through a visual analogue scale (VAS), at the beginning of the operation and after 30 minutes of the procedure. Scores will be compared.

Background: During operations conducted under spinal anaesthesia patients are aware of their environment, including sounds related to operative instruments and the voices of staff. This has the potential to cause anxiety and amplify existing anxiety which can negatively impact patient experience and outcomes. Research has shown peri-operative music can reduce anxiety but there is no robust evidence for the effect of intraoperative music on intraoperative anxiety. Objectives: The primary objective is to determine the effects of intraoperative music on intraoperative anxiety levels for patients undergoing procedures conducted under spinal anaesthesia. The secondary objectives are to investigate whether participants feel that music improved/would improve their experience and whether they would choose it in future or recommend it for others. Methods: This prospective randomised controlled trial will be conducted at the Children's Surgical Centre in Phnom Penh. Participants will be 18 years or over, due to undergo a procedure that requires spinal anaesthesia and not have a medical history that fulfils any of the exclusion criteria. The trial will aim to recruit between 16 and 28 patients consecutively once it commences, and participants will be randomised to either the music (M) group or the 'control' (C) group. The M group will receive music (pre-selected from 5 categories) played through headphones for the duration of the operation. The C group will receive no music or headphones. Anxiety will be measured in both groups, through a visual analogue scale (VAS), at the beginning of the operation and after 30 minutes of the procedure. In the recovery room the participants will be asked two questions relating to experience and future recommendations. Results: The VAS scores and change in VAS scores will be displayed as mean ± Standard Error and the results from the two groups will be compared using a student's paired t-test or a Mann-Whitney U test depending on the distribution of the data. The results from the post-operation questions will be displayed as frequencies and the answers will be compared using a χ2 test. All tests will be 2-tailed and P<0.05 will be considered significant

This is a single-centre, prospective, randomised controlled trial. Patients will be invited to participate if they are due to undergo a procedure for which they will require spinal anaesthesia and if they meet the inclusion criteria and none of the exclusion criteria. They will not be required to make any additional hospital visits and will be asked to give their informed consent prior to the procedure. Half of the participants will receive music from the start of surgery until completion of the operation and the other half will serve as the 'control group' and will receive no headphones or music. The anxiety of participant's during the operation will be assessed through a VAS and they will be asked questions about their experience afterwards. The anxiety scores from the two groups will be compared, as will their responses to the questions about their experience, in order to elucidate whether the music produced any differences in anxiety or experience.

Score on 'Anxiety visual analogue scale.' Minimum score 0 representing calm and maximum score 10 representing extreme anxiety

Percentage of patient's in the music group who felt that music made the experience better, worse or had no effect.

Questionnaire asked verbally. What effect do you think music had on your experience during surgery? a) made it better b)made it worse c)no effect.

Percentage of patient's in the music group who felt that they would recommend to others, wouldn't recommend to others or did not know.

Questionnaire asked verbally. Would you recommend listening to music during an operation to other people? a)yes b)no c) don't know

Percentage of patient's in the control group who felt that music would have made their experience better, worse or the same.

What effect do you think music would have had on your experience during surgery? a) made it better b)made it worse c)no effect.

Percentage of patient's in the music group who, if they had another operation, would like to listen to music, would not like to listen to music, or did not know.

Questionnaire asked verbally. Would you like to listen to music if you were to have another operation? a)yes b)no c) don't know

Questionnaire on data collection form. Do you think that the music caused any problems during the operation? a)yes b)no c)maybe

Inclusion Criteria: 18 years of age and older Undergoing a procedure at CSC that requires spinal anaesthesia and spinal anaesthesia is not contra-indicated Gives informed consent to participate in the trial Exclusion Criteria: Has an existing psychological diagnosis Has auditory impairment Deemed not to have capacity to give consent Sedatives are administered during the procedure General anaesthesia is required during the procedure

De-identified individual participant data for all primary and secondary outcome measures will be made available.

Requests will be reviewed by an independent review panel and all requestors will be required to sign a data access agreement.

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