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Music Interventions in Pediatric Surgery (The Music Under Surgery In Children Study)

A Randomized Clinical Trial

Kühlmann, A. Y. Rosalie, MD*; van Rosmalen, Joost, PhD; Staals, Lonneke M., MD, PhD; Keyzer-Dekker, Claudia M. G., MD, PhD*; Dogger, Jaap, MPA; de Leeuw, Tom G., MD; van der Toorn, Fred, MD§; Jeekel, Johannes, MD, PhD; Wijnen, Rene M. H., MD, PhD*; van Dijk, Monique, PhD*,¶

doi: 10.1213/ANE.0000000000003983
Pediatric Anesthesiology: PDF Only

BACKGROUND: Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery.

METHODS: The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children’s hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0–3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (

RESULTS: One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3–11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, −1.22; 95% CI, 2.60–0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069).

CONCLUSIONS: Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.

From the *Department of Pediatric Surgery, Erasmus University Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands

Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands

Departments of Anesthesiology

§Pediatric Urology, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam, the Netherlands

Departments of Neuroscience

Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.

Accepted for publication November 13, 2018.

Funding: This study was funded by Prins Bernhard Cultuurfonds, Amsterdam, the Netherlands, and by Stichting Swart van Essen, Rotterdam, the Netherlands. The funders of the study had no role in the study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.

The authors declare no conflicts of interest.

Clinical trial number: Dutch Trial Register NTR5402;

Reprints will not be available from the authors.

Address correspondence to A. Y. Rosalie Kühlmann, MD, Department of Pediatric Surgery, Erasmus Medical Center–Sophia Children’s Hospital, PO Box 2060, Room SK1264, 3000CA Rotterdam, the Netherlands. Address e-mail to

© 2019 International Anesthesia Research Society
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