Hindu Spiritual Music for Perioperative Anxiolysis and Stress Modulation: An Open-Label, Randomized Comparative Trial in Lower Limb Surgery Patients.

Abstract

Background Perioperative anxiety is a common concern in patients undergoing regional anesthesia, as they remain conscious during surgery. Various non-pharmacological interventions, including music therapy, have been explored to reduce anxiety and stress response. Spiritual interventions, particularly religious music, have been shown to provide emotional stability and enhance coping mechanisms during stressful situations. Objective This study aimed to evaluate the impact of Hindu religious music compared to patient-selected instrumental music on intraoperative anxiety, stress response, and patient satisfaction in individuals undergoing lower limb surgery under regional anesthesia. Methods This prospective, open-label, randomized controlled trial was conducted at Maharani Laxmi Bai Medical College, a tertiary care teaching hospital in Jhansi, India, after obtaining approval from the Institutional Ethics Committee (Certificate No. 5208/IEC/I/2022-2023) and registration with the Clinical Trials Registry of India (CTRI/2024/01/062006, registered on January 30, 2024). The trial included 150 ASA class 1 or 2 patients undergoing elective lower limb surgery under regional anesthesia. Participants were randomly assigned to two groups: Group A (Hindu spiritual music) and Group B (patient-preferred instrumental music). Music was played intraoperatively via noise-canceling headphones. The primary outcomes were intraoperative anxiety (measured using the Visual Analog Scale for Anxiety (VAS-A)) and serum cortisol levels as a biochemical marker of stress. Secondary outcomes included hemodynamic parameters, additional analgesic requirements, incidence of nausea and vomiting, and patient satisfaction. Results Group A had significantly lower intraoperative VAS-A scores compared to Group B (2.13 ± 0.91 vs. 3.41 ± 1.12; p = 0.01). Serum cortisol levels were also significantly lower in Group A at the end of surgery (28.54 ± 6.11 vs. 32.50 ± 8.82 µg/dL; p = 0.001) and remained lower on the first postoperative day (p = 0.001). The incidence of postoperative nausea and vomiting was significantly lower in Group A (6.8% vs. 17.5%; p = 0.028). Patient satisfaction was also higher in the Hindu spiritual music group (p = 0.03). Conclusion Hindu spiritual music reduced perioperative anxiety, attenuated the stress response, and decreased postoperative nausea and vomiting compared to non-spiritual instrumental music. It should be considered a non-pharmacological intervention in the perioperative period to alleviate anxiety and improve patient comfort. However, the study's findings may have limited generalizability to non-Hindu patients. Future research should explore whether similar benefits are observed in religious individuals listening to music of their own faith and cultural background.