The Effect of Music Therapy After Bariatric Surgery on Postoperative Nausea Vomiting and Patient Satisfaction (BSMusicPONV)

The Effect of Music Therapy After Bariatric Surgery on Postoperative Nausea Vomiting and Patient Satisfaction

Bariatrik Cerrahi Sonrası Müzik Terapinin Postoperatif Bulantı Kusmayı Azaltma ve Hasta Memnuniyeti Üzerine Etkisi

In this study, it was planned to evaluate the effectiveness of the use of music therapy, which is a non-pharmacological method, in addition to pharmacological treatment in patients with PONV after bariatric surgery, whose application frequency is increasing in the treatment of obesity, and to determine its effect on patient satisfaction. The findings of this study are considered to be effective in preventing nausea and vomiting, providing patient comfort, increasing evidence-based nursing knowledge and increasing the quality of care.

Postoperative nausea and vomiting (POBK) according to ASPAN (American Society of PeriAnesthesia Nurses) are Nausea and vomiting seen in the first 24 hours after surgery (1). While PONV is seen in 20-30% of patients after general anesthesia, this rate increases up to 80% in high-risk patients (2). PONV, which is the second most common postoperative complaint after pain, is a stressful and uncomfortable situation for patients, but it can cause serious complications. These complications are; dehydration, electrolyte imbalance, acid-base imbalance, pulmonary aspiration, pneumothorax, hypoxia, esophageal rupture, increased intracranial pressure, suture rupture, bleeding (3). Due to the long duration of general anesthesia and the use of high-dose opioids, the incidence of PONV is higher in some types of surgery (eg, abdominal surgeries) (4). Recent studies have shown that laparoscopic, gynecological and cholecystectomy surgeries are high-risk surgeries in terms of PONV (5). While obesity ranks second among the preventable causes of death in the world, bariatric surgery is seen as the most effective method in the treatment of morbid obesity (6). Bariatric surgeries are surgeries that carry a high risk in terms of PONC, since they are abdominal surgery, performed under general anesthesia, and the laparoscopic method is preferred. Antiemetics can be used in high-risk patients after risk factors are determined to prevent PONV. However, due to complications, the effectiveness of the use of antiemetic drugs in the management of PONC remains limited (7). Published guidelines on PONC management recommend the use of non-pharmacological methods in addition to pharmacological treatment in patients at high risk for PONV. Some of the complementary methods used to prevent PONV are acupuncture, aromatherapy, acupressure, progressive relaxation exercises, hypnosis, massage, and music therapy (7). It has been reported in the literature that music therapy is a non-pharmacological nursing practice that is used to manage nausea-vomiting and the severity of symptoms, has no side effects, is easy to use (8). In addition, it has been noted that music therapy has positive effects on analgesic requirement, hospital stay, reducing fatigue and the use of antiemetic drugs (8). Çetinkaya's study to determine the effect of music on the severity of postoperative nausea and vomiting after laparoscopic cholecystectomy showed that listening to music reduces the severity of nausea and the frequency of nausea (9). According to a randomized controlled study conducted by Madson and Silverman in a group of 58 solid organ transplant patients, less nausea and vomiting were found in the music therapy group (10). In a study conducted by Nilsson et al. on hysterectomy patients who underwent general anesthesia in the intraoperative period, it was observed that music did not affect nausea and vomiting (11). In another study by Laurion and Fetzer, it was reported that music had no effect on PONV (12). In the fourth consensus guideline on the treatment of postoperative nausea and vomiting, it has been reported that music is not an effective prophylactic method for PONV, but this information is based on a single randomized controlled study (12,13). When the literature is examined, it has been determined that there is no common view on the use of music therapy as a complementary method in the management of PONV and more studies should be done on this subject. Aspan's evidence-based clinical practice guideline for the prevention and/or management of PONV/PDNV. J PeriAnesthesia Nurs. 2006, 21:230-250. Amirshahi M, Behnamfar N, Badakhsh M, Rafiemanesh H, Keikhaie KR, Sheyback M, Sari M. Prevalence of postoperative nausea and vomiting: A systematic review and meta-analysis. Saudi J Anaesth. 2020, 14:48-56 Lazo O., Paul F., R. Yumul, Cruz H Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Research, (2020)(Faculty Rev):983 Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012; 109: 742-53. Abd Elrazek AEMA, Elbanna AEM, Bilasy SE. Medical management of patients after bariatric surgery: Principles and guidelines. World J Gastrointest Surg 2014;6(11): 220-228. Güven B., Bariatrik Cerrahi Komplikasyonları ve Hemşirelik Bakımı, Hemşirelikte Eğitim Ve Araştırma Dergisi, 2019;16 (2): 139-143 H. Shabandokht-Zarmi, M. Bagheri-Nesami, S. Afshin Shorofi, S. Nouraddin Mousavinasab The effect of self-selected soothing music on fistula puncture-related pain in hemodialysis patients Complement. Ther. Clin. Pract., 29 (2017), pp. 53-57 S. Nicolete , JG Tong , J. Nicholas , U. Alberto , P. Jyoti , D. Rohan , DB Sergio Alternative therapies for the prevention of postoperative nausea and vomiting Front. Med. , 2 ( 2015 ) Çetinkaya F. The effects of listening to music on the postoperative nausea and vomiting. Complementary Therapies in Clinical Practice 35 (2019) 278-283 Madson AT, Silverman MJ. The effect of music therapy on relaxation, anxiety, pain perception, and nausea in adult solid organ transplant patients. J Music Ther 2010;47(3):220-32 U. Nilsson, N. Rawal, L.E. Uneståhl, C. Zetterberg, M. Unosson. Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial Acta Anaesthesiol. Scand., 45 (2001), pp. 812-817 S. Laurion, S.J. Fetzer The effect of two nursing interventions on the postoperative outcomes of gynecologic laparoscopic patients J Perianesth Nurs, 18 (2003), pp. 226-254 Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting, Anesth Analg. (2020) Aug;131(2):411-448.

Simplified postoperative nausea and vomiting impact scale Developed by Myles and Wengritzky in 2012 and consisting of two questions, there are four options for each question that can be scored 0, 1, 2, 3 points. The first question asks whether there is vomiting or retching, if so, the frequency, and the answers are "0" no, "1" once, "2" twice, "3" three or more times and have four choices. In the second question, it is questioned whether there is nausea (feeling of discomfort in the stomach and feeling like vomiting), whether the feeling of nausea, if any, affects your daily life activities such as getting out of bed, moving comfortably in bed, walking normally, or eating and drinking; The answers are "0" not much, "1" sometimes, "2" often or often, "3" always. The numerical value of the answers given to the first and second questions is added and the result is found. A score of five or more on the scale defines "clinically significant nausea and vomiting".

Simplified postoperative nausea and vomiting impact scale Developed by Myles and Wengritzky in 2012 and consisting of two questions, there are four options for each question that can be scored 0, 1, 2, 3 points. The first question asks whether there is vomiting or retching, if so, the frequency, and the answers are "0" no, "1" once, "2" twice, "3" three or more times and have four choices. In the second question, it is questioned whether there is nausea (feeling of discomfort in the stomach and feeling like vomiting), whether the feeling of nausea, if any, affects your daily life activities such as getting out of bed, moving comfortably in bed, walking normally, or eating and drinking; The answers are "0" not much, "1" sometimes, "2" often or often, "3" always. The numerical value of the answers given to the first and second questions is added and the result is found. A score of five or more on the scale defines "clinically significant nausea and vomiting".

Simplified postoperative nausea and vomiting impact scale Developed by Myles and Wengritzky in 2012 and consisting of two questions, there are four options for each question that can be scored 0, 1, 2, 3 points. The first question asks whether there is vomiting or retching, if so, the frequency, and the answers are "0" no, "1" once, "2" twice, "3" three or more times and have four choices. In the second question, it is questioned whether there is nausea (feeling of discomfort in the stomach and feeling like vomiting), whether the feeling of nausea, if any, affects your daily life activities such as getting out of bed, moving comfortably in bed, walking normally, or eating and drinking; The answers are "0" not much, "1" sometimes, "2" often or often, "3" always. The numerical value of the answers given to the first and second questions is added and the result is found. A score of five or more on the scale defines "clinically significant nausea and vomiting".

Simplified postoperative nausea and vomiting impact scale Developed by Myles and Wengritzky in 2012 and consisting of two questions, there are four options for each question that can be scored 0, 1, 2, 3 points. The first question asks whether there is vomiting or retching, if so, the frequency, and the answers are "0" no, "1" once, "2" twice, "3" three or more times and have four choices. In the second question, it is questioned whether there is nausea (feeling of discomfort in the stomach and feeling like vomiting), whether the feeling of nausea, if any, affects your daily life activities such as getting out of bed, moving comfortably in bed, walking normally, or eating and drinking; The answers are "0" not much, "1" sometimes, "2" often or often, "3" always. The numerical value of the answers given to the first and second questions is added and the result is found. A score of five or more on the scale defines "clinically significant nausea and vomiting".

Simplified postoperative nausea and vomiting impact scale Developed by Myles and Wengritzky in 2012 and consisting of two questions, there are four options for each question that can be scored 0, 1, 2, 3 points. The first question asks whether there is vomiting or retching, if so, the frequency, and the answers are "0" no, "1" once, "2" twice, "3" three or more times and have four choices. In the second question, it is questioned whether there is nausea (feeling of discomfort in the stomach and feeling like vomiting), whether the feeling of nausea, if any, affects your daily life activities such as getting out of bed, moving comfortably in bed, walking normally, or eating and drinking; The answers are "0" not much, "1" sometimes, "2" often or often, "3" always. The numerical value of the answers given to the first and second questions is added and the result is found. A score of five or more on the scale defines "clinically significant nausea and vomiting".

Numerical Rating scale consisting of numbers between "0" and "10" (0: not at all satisfied 10: very satisfied) have been used to determine the satisfaction level of patients at the 24th postoperative hour.

Inclusion Criteria: Cognitive functions are sufficient, Able to communicate in Turkish, Between the ages of 18-80, Patients who voluntarily participated in the study Exclusion Criteria: Patients who did not volunteer for the study, Patients who underwent open surgery whose mother tongue is not Turkish