Surgery and preoperative waiting are anxiety-provoking situations (1, 2). It is estimated that the prevalence of preoperative anxiety ranging from 25 to 80% depending on the type of surgery (3, 4). Being in an unknown environment, the sense of losing control, perception of physical risk, dependence on strangers, separation from relatives, per and postoperative complications, and fear of mutilation, anaesthesia and death are all factors that can trigger or aggravate preoperative anxiety (4–6).
This is especially the case in the context of gynaecological surgery, which most often results in the partial or total removal of an organ that is necessarily linked to maternity or femininity. Sexuality can be damaged (7). For example, physical and psychological post-operative impacts of hysterectomy are real: hot flushes, night sweats, urinary incontinence and urge incontinence (8). The fear of pain, feeling of being rejected by their spouses, sensation of mutilation were expressed by patients (9).The surgical management of gynaecological cancer can cause short- and long-term effects on sexuality, emotional well-being, reproductive function, and overall quality of life (10).
High levels of anxiety result in the activation of the autonomic nervous system and in negative physiological manifestations (2, 11–13). These manifestations slow down the healing process, decrease the immune response and increase the risk of infection, postoperative complications, pain, morbidity and mortality (2, 4). Preoperative anxiety might cause hemodynamic problems in the intraoperative period, increased analgesic need and lower postoperative satisfaction of the patients in the postoperative period (14).
High levels of anxiety can complicate the administration of preoperative drugs, while negatively interfering with the induction of anaesthesia and delaying recovery (15).
In view of the above, reducing preoperative anxiety appears to be essential. Traditionally, the reduction of preoperative anxiety was based on the use of sedatives or anti-anxiety drugs administered prophylactically in the preoperative phase. However, these treatments can have negative side effects like drowsiness and respiratory depression. They can also interact with anaesthetic agents by prolonging the recovery phase and the duration of hospitalization (16). In recent years, non-drug strategies have been developed to reduce preoperative anxiety. Acupuncture (17), hypnosis (18), non-pharmacological and non-prescription medicinal plant use (19), relaxation therapy (20) and Raj Yoga meditation (21) are among the techniques that have been shown to significantly reduce preoperative anxiety during hospitalization. Music therapy is one of these alternative strategies. A 2013 Cochrane systematic review concluded that music interventions can provide a viable alternative to sedatives and anti-anxiety drugs for the reduction of preoperative anxiety (2). A common theory regarding the anxiety-reducing effects of music is that music can help patients focus their attention away from stressful events to something pleasant and soothing(2, 22).
In surgical context, listening to music has an effect on blood pressure and pulse rate, and the classic music resulted in lowered blood pressure and heart rate (23). In addition, a 2014 randomized control trial found that anxiety scores and physiological parameters measured before gynaecological surgery were significantly lower in patients who had received music interventions than in those who had received standard care alone (24). This study is the only we found in the context of gynaecological surgery.
To date, however, most published controlled randomized trials have evaluated the effects of music interventions on preoperative anxiety by comparing patients who listen to researcher-selected or predetermined music with patients who receive standard care alone. Few studies have compared the impact of different styles of music on preoperative anxiety (25). This is unfortunate, as music may be perceived as relaxing or not depending on its intrinsic characteristics, which include complexities of tempo, harmony, rhythm, dynamic variations, and melody. Personal preferences, familiarity and popularity may be key elements for an optimal relaxation response to music (25, 26). Perceptions of music styles, rhythms, and sounds are known to vary depending on cultural background, ethnicity, and personal experience (27). For example, Sega and Maloya are two popular music styles of Reunion Island, which is a French overseas territory with a multiethnic and multicultural population (28, 29). These styles of music, also known as “Creole music”, are based on a traditional ensemble with African and Malagasy rhythmic influences.
Our study seeks to fill this gap in the literature by letting patients create their own, culturally adapted music playlist. Our hypothesis was that music therapy programs, which use specific rhythm sequences to potentiate the anxiolytic effects of music, could be optimized by adapting them to the preferences and cultural contexts of patients.
The aim of our study was to determine whether listening to self-selected music decreases preoperative anxiety in women scheduled to undergo gynaecologic surgery as compared with predetermined music from a music therapy software programme (MUSIC CARE®). Physiological parameters evolutions after the music session, post-operative pain intensity, duration of post-surgical hospitalization were also compared.