Efeito da audição musical sobre ansiedade, dor e parâmetros cardiorrespiratórios em cirurgia cardíaca: ensaio clínico randomizado

Abstract

Cardiac surgeries, complex and large procedures, have a significant emotional impact on patients, highlighting anxiety as the predominant emotion in the preoperative period and which can contribute to future complications. In the postoperative period, pain has also been shown to be frequent and, when not properly treated, can cause several side effects related to unpleasant patient experiences, negative clinical outcomes and costbenefit problems. In this context, non-pharmacological interventions deserve to be highlighted as beneficial strategies to be combined with pharmacological treatment and among these interventions, the use of music shows positive results in reducing anxiety and pain. The general objective of this research was to evaluate the effect of listening to music on preoperative anxiety-state, postoperative pain, at rest and when instructed to cough, and cardiorespiratory parameters in patients undergoing cardiac surgery. This is a single-center, randomized, parallel, superiority clinical trial with simple blinding, whose protocol followed the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guideline and the research report was prepared in accordance with the Consolidated Standards of Reporting Trials (CONSORT) Declaration. The research was approved by the Research Ethics Committee and registered in the Brazilian Clinical Trials Registry (ReBEC) platform under number RBR-8mdyhd. The study was carried out at the Hospital de Clínicas of the Federal University of Triângulo Mineiro, in Uberaba, Minas Gerais, Brazil, with adult patients undergoing elective cardiac surgery, of both sexes. Fifty patients were analyzed, who were randomly allocated to one of the groups, experimental or control. Patients in the experimental group were submitted to music listening, lasting 20 minutes, in the immediate preoperative period and on the 1st postoperative day through headphones, while patients in the control group received standard care. Data collection was performed at the patient's bedside, once a day, in the immediate preoperative period and on the 1st postoperative day, and data related to the anesthetic-surgical procedure were collected from the patient's medical record. For the statistical analysis, the validated database was imported into the Statistical Package for the Social Sciences (SPSS) version 21.0 program and the process was assisted by the statistician. The results showed that the applied musical intervention significantly reduced the preoperative anxiety-state scores (p<0.001; dCohen=2.1), as well as significantly reduced the intensity of postoperative pain at rest (p<0.001; dCohen =1.4) and to the cough stimulus (p<0.001; dCohen=1.3). The effects were also positive on cardiorespiratory parameters, both preoperatively and postoperatively, as there was a statistically significant reduction in systolic and diastolic blood pressure, heart rate and respiratory rate, and a significant increase in oxygen saturation. It was concluded that listening to music was effective in terms of the evaluated outcomes and can be indicated for patients undergoing cardiac surgery as a complementary intervention to pharmacological treatment. The findings presented have implications for clinical practice, as they reinforce the evidence that listening to music is a promising nursing intervention to be used in the perioperative period of cardiac surgeries, with the potential to promote well-being to patients and improve the quality of care provided.