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Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study
  1. Veena Graff,
  2. Lu Cai,
  3. Ignacio Badiola and
  4. Nabil M Elkassabany
  1. Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Veena Graff, Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA; veena.graff{at}


Background and objectives Music medicine is a non-pharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety. In this study we aim to compare the use of music to midazolam as a preoperative anxiolytic prior to the administration of an ultrasound-guided single-injection peripheral nerve block.

Methods In this randomized controlled study we compared the anxiolytic effects of intravenous midazolam (1–2 mg) with noise-canceling headphone-delivered music medicine. All patients received a preoperative ultrasound-guided single-injection peripheral nerve block indicated for a primary regional anesthetic or postoperative analgesia.

Results The change in the State Trait Anxiety Inventory-6 (STAI-6) anxiety scores from after to before the procedure were similar in both groups (music group −1.6 (SD 10.7); midazolam group −4.2 (SD 11); p=0.14; mean difference between groups −2.5 (95% CI −5.9 to 0.9), p=0.1). Patient satisfaction scores with their procedure experience were higher in the midazolam group (p=0.01); however, there were no differences in physician satisfaction scores of their procedure experience between groups (p=0.07). Both patient and physician perceptions on difficulties in communication were higher in the music group than in the midazolam group (p=0.005 and p=0.0007, respectively).

Conclusions Music medicine may be offered as an alternative to midazolam administration prior to peripheral regional anesthesia. However, further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.

Clinical trial registry #NCT03069677

  • music medicine
  • music therapy
  • regional anesthesia
  • nerve blocks
  • preoperative anxiety

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  • Presented at Interim data from this work were presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine in New York City, April 19 to April 21, 2018.

  • Contributors All authors listed in this manuscript have contributed substantially with planning, conducting, reporting, designing, analyzing, interpreting the data and in writing and editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board (IRB) at the University of Pennsylvania has approved this randomized controlled study conducted at a university-based ambulatory surgical center

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.