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American Association for Hand Surgery

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Noise Cancelling Headphones and Music Decrease Intraoperative Patient Anxiety During Wide Awake Hand Surgery: A Prospective Randomized Study
Asif M Ilyas, MD, Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA

PURPOSE: Wide Awake Local Anesthesia No Tourniquet (WALANT) hand surgery has grown in popularity due to its cost savings, safety, favorable outcomes, and high patient satisfaction. However, the wide awake nature of the technique results in many patients experiencing anxiety during the procedure. Many previous studies have reported the anxiolytic effects of intra-operative music in a variety of wide awake medical procedures. This prospective randomized study investigated the effects of noise cancelling headphones and listening to music on patient anxiety during WALANT hand surgery.
METHODS: Institutional review board approval was obtained. Patients were randomized into either: 1) Headphones group that wore noise cancelling headphones and listened to music (genre of their choice) during surgery, or 2) Control group that neither wore noise cancelling headphones nor listened to music during surgery. Patient anxiety was assessed on a 10 point visual analog scale pre-operatively, intra-operatively, and post-operatively. Post-operatively all patients completed an overall experience questionnaire.
RESULTS: Fifty patients were enrolled, with 25 in each group. There were no differences between groups in patient characteristics, diagnosed anxiety, and preoperative levels of anxiety. The headphones group was found to have significantly less intra-operative anxiety (1.02 vs 2.32; p=0.017) and a significantly greater net decrease in anxiety from pre-operative to intra-operative level (-1.78 vs -0.56; p=0.033) compared to the control group. In the headphones group, 92% of patients (23/25) would recommend noise cancelling headphones and music to other WALANT hand surgery patients. All patients in both groups (50/50) would choose to have their hand surgery performed under WALANT if they had to have another surgery.
CONCLUSIONS: Noise cancelling headphones with music during WALANT hand surgery significantly decreased intra-operative patient anxiety. This intervention represents an effective, safe, and cost efficient nonpharmacologic measure to improve patient anxiety and overall experience with WALANT hand surgery.


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