Yu Rongguo, Zhuo Youguang, Feng Eryou, Wang Wulian, Lin Wentao, Lin Feitai, Li Zhanglai, Lin Liqiong, Xiao Lili, Wang Haiyang, Huang Yuting, Wu Chunlin, Zhang Yiyuan
Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China.
J Orthop Surg Res. 2020 Oct 9;15(1):465. doi: 10.1186/s13018-020-01995-x.
A growing number of patients continue to receive total knee replacement (TKR) surgery. Nevertheless, such surgeries result in moderate to severe postoperative pain and difficulty in managing it. Musical interventions are regarded as a type of multimodal analgesia, achieving beneficial results in other clinical treatments. This study aims to evaluate the effect of musical interventions in improving short-term pain outcomes following TKR in order to determine a more reasonable and standard way of delivering musical intervention.
A systematic search was conducted to identify available and relevant randomized controlled trials (RCTs) regarding musical interventions compared against non-musical interventions in patients treated with TKR in Embase, MEDLINE, Cochrane Library, Web of Science, CNKI, and Wanfang Med Online up to 8 January 2020. The authors independently assessed study eligibility and risk of bias and collected the outcomes of interest to analyze. The statistical analysis was conducted using the Review Manager (RevMan) version 5.30 software.
Eight RCTs comprised of 555 patients satisfied the inclusion criteria and were enrolled in the present study. The results showed no significant difference between the music and control groups in pain of the visual analog scale (VAS), during postoperative recovery room, back to the ward after surgery; anxiety degree of VAS; heart rate; respiratory rate; oxygen saturation; blood pressure, systolic blood pressure, and diastolic blood pressure. Nevertheless, significant differences were observed between the two groups in average increase in continuous passive motion (CPM) angles and LF/HF ratio (one kind index of heart rate variability).
Musical interventions fail to demonstrate an obvious effect in improving short-term pain outcomes following TKR. A reasonable standardization of musical interventions, including musical type, outcome measures used, outcomes measured, duration, timing and headphones or players, may improve pain outcomes with certain advantages and should be further explored after TKR.
越来越多的患者继续接受全膝关节置换术（TKR）。然而，此类手术会导致中度至重度术后疼痛且难以控制。音乐干预被视为一种多模式镇痛方法，在其他临床治疗中取得了有益效果。本研究旨在评估音乐干预对改善TKR术后短期疼痛结局的效果，以确定更合理、规范的音乐干预实施方式。
进行系统检索，以识别截至2020年1月8日在Embase、MEDLINE、Cochrane图书馆、科学网、中国知网和万方医学在线上有关TKR患者中音乐干预与非音乐干预比较的可用且相关的随机对照试验（RCT）。作者独立评估研究的纳入资格和偏倚风险，并收集感兴趣的结局进行分析。使用Review Manager（RevMan）5.30版软件进行统计分析。
八项RCT（共555例患者）符合纳入标准并纳入本研究。结果显示，在术后恢复室、术后返回病房时，音乐组和对照组在视觉模拟量表（VAS）疼痛、VAS焦虑程度、心率、呼吸频率、血氧饱和度、血压、收缩压和舒张压方面无显著差异。然而，两组在连续被动运动（CPM）角度的平均增加量和LF/HF比值（心率变异性的一种指标）方面存在显著差异。
音乐干预在改善TKR术后短期疼痛结局方面未显示出明显效果。对音乐干预进行合理规范，包括音乐类型、所使用的结局指标、测量的结局、持续时间、时机以及耳机或播放器等，可能会在具有一定优势的情况下改善疼痛结局，TKR术后应进一步探索。
