Table 1 Characteristics of the included studies

Bethune et al. (1993) [47]

UK

Coronary artery bypass grafting

Positive; based on text used by Evans & Richardson (1988) [48]; music at the beginning

16

Blank tape with musical leader

17

I

Mental distress (mood, anxiety)

Pain intensity

Recovery (nausea, mobility, general recovery)

Length of procedure

Block et al. (1991) [15]

USA

Operation on the fallopian tubes, vertical banding gastroplasty, total abdominal hysterectomy, ovarian cystectomy, cholecystectomy, myomectomy

Smooth, rapid recovery during a short post-operative stay; no pain, nausea or vomiting; rapid return of bowel and bladder function; rapid healing and mobility; comfort; relaxation; good appetite, sleep, mood, and feeling

109

Blank tape

100

I

Medication (antiemetics, Analgesics)

Length of procedure

Boeke et al. (1988) [49]

NL

Elective cholecystectomy

Relaxation, wellbeing, pleasant feeling in every respect, absence of nausea and vomiting, good recovery; with seaside sounds

24

Nonsense suggestions with seaside sounds

26

N

Mental distress (well-being)

Pain intensity

Recovery (nausea, general recovery)

Length of procedure

Physiological parameters (blood loss)

Bonke et al. (1986) [50]

NL

Biliary tract surgery

Relaxation, well-being, comfortable feelings in every respect, lack of nausea or vomiting, no difficulty with bladder function or bowel movement, rapid recovery

31

Monotonous low-frequency noise, resembling the sound of a vacuum cleaner

30

N

Mental distress (well-being, relaxation)

Pain intensity

Medication (analgesics)

Recovery (PONV, general recovery)

Length of procedure

Physiological parameters (blood loss)

Caseley-Rondi et al. (1994) [51]

Canada

Elective total abdominal hysterectomy and/or bilateral salpingo oophorectomy

Simple and positive; alternating with Japanese melodies

48

Blank tape alternating with Japanese melodies

48

I

Mental distress (mood, anxiety)

Pain intensity

Medication (analgesics)

Recovery (nausea, general recovery)

Cowan et al. (2001) [52]

USA

Bariatric surgical patients

Positive; cognitive-behavioural approach: reinforcement of information received preoperatively, encouragement of performance of recovery regimes, positive interactions with personnel, improved self-image, relaxation

10

Blank tape

17

I

Recovery (turning, coughing, breathing, mobility)

Dawson et al. (2001) [29]

UK

Total abdominal hysterectomy with/without bilateral salpingo oophorectomy

(1) No pain

(2) No sickness

(3) No sickness, no pain

35

34

34

White noise

35

N (no N₂O)

Pain intensity

Medication (antiemetics, analgesics)

Recovery (PONV)

Length of procedure

De Houwer et al. (1996) [53]

Belgium

Coronary artery bypass grafting

Relaxation, fast recovery; based on Bonke et al. (1986) [50]; with background relaxing music

19

Blank tape

21

T

Mental distress (mood, anxiety)

Recovery (general recovery)

Length of procedure

Physiological parameters (blood pressure, noradrenalin, adrenalin)

Eberhart et al. (1998) [54]

Germany

Thyroidectomy

Smooth postoperative recovery; relaxation, security, absence of nausea and vomiting

36

Blank tape

35

N

Medication (antiemetics, analgesics)

Recovery (PONV)

Length of procedure

Evans & Richardson (1988) [48]

UK

Total abdominal hysterectomy

Direct (no sickness, no pain), third person (operation is going very well and the patient is fine), description of normal postoperative procedures and coping advices

19

Blank tape

20

I

Mental distress (anxiety, mood)

Pain intensity

Recovery (PONV, pyrexia, bowel difficulties, flatulence, mobility, micturation, general recovery, complications)

Length of procedure

Physiological parameters (blood loss)

Furlong (1990) [55]

USA

Abdominal gynecological surgery

Positive

10

Blank tape

9

I

Mental distress (mood) Medication (analgesics)

Length of procedure

Furlong & Read (1993) [56]

USA

Gynecological surgery or mastectomy

Positive; with background music

52

Blank tape

56

I

Mental distress (anxiety)

Pain intensity

Medication (analgesics)

Recovery (PONV, mobility, bowel difficulties, micturition, wound healing)

Jelicic et al. (1993) [30]

NL

Cholecystectomy

(1) Affirmative (relaxation, comfort, quick healing) and non-affirmative (absence of tension, nausea); alternating with seaside sounds

(2) Affirmative

(3) Non-affirmative

21

20

20

Irrelevant text, i.e. excerpts from a cookery book

21

N

Mental distress (well-being)

Length of procedure

Physiological parameters (blood loss)

Korunka et al. (1992) [40]

Austria

Hysterectomy

Positive; followed by indirect (general wellbeing, absence of pain)

55

Operation sounds

53

I

Pain intensity

Medication (analgesics)

Length of procedure

Lebovits et al. (1999) [57]

USA

Elective hernia repair

Positive postoperative course, well-being and relaxation, minimal side effects, no difficult voiding, minimal discomfort such as sore throat, muscle aches and emetic symptoms; requirement of minimal pain medication

34

History of hospital

36

T

Pain intensity

Medication (analgesics)

Recovery (PONV, side effects)

Length of procedure

Liu et al. (1992) [58]

UK

Total abdominal hysterectomy

Affirmative and non-affirmative (comfort and rapid recovery; absence of pain or feelings of sickness)

24

History of hospital

25

I

Mental distress (mood)

Pain intensity

Medication (analgesics)

Recovery (nausea, pyrexia, wound healing, mobility, flatulence)

Length of procedure

Physiological parameters (blood loss)

Liu et al. (1993) [59]

UK

Surgical repair of fractured neck of femur

Positive (relating to comfort, mobility, nausea, general recovery and discharge after surgery)

58

History of hospital

61

GA

Pain intensity

Medication (analgesics, antiemetics)

Recovery (ADL, mobility, pyrexia)

Maroof et al. (1997) [60]

Saudi Arabia

Elective abdominal hysterectomy

Positive (good progress, well-being after surgery, absence of sickness)

25

Blank tape

25

I

Medication (antiemetics)

Recovery (PONV, fluid replacement)

Length of procedure

Mastropietro (1998) [31]

USA

Open gynaecological procedures through a midline incision

(1) Synchronized with soothing music presented when stress test was positive (comfortable, relaxed intraoperative and postoperative experience)

(2) Randomly presented with soothing music (comfortable, relaxed intraoperative and postoperative experience)

24

McLintock (1990) [61]

UK

Elective abdominal hysterectomy by Pfannenstiel’s incision

Positive (positive progress, feelings of warmth, comfort, calmness and relaxation; absence of pain)

30

Blank tape

30

I

Pain intensity

Medication (analgesics)

Recovery (PONV)

McWilliams (1990) [62]

USA

Lumbar laminectomy surgery

Suggestions interspersed with environmental sounds

30

Environmental sounds alone

30

GA

Medication (analgesics, antiemetics)

Recovery (general recovery)

Melzack et al. (1996) [63]

Canada

Cholecystectomy or hyterectomy

Positive; regarding the recovery process (e.g., feeling fine, mild pain only); interspersed with music

10

Excerpts from physiology book

10

I

Pain intensity

Length of procedure

Moix et al. (1996) [64]

Spain

Abdominal hysterectomy

Affirmative (feeling of relaxation during surgery, good progress, easy and rapid recovery, rapid mobility, comfort, good appetite, digestion, micturition, sleep and mood)

14

Monotonous sounds

13

I

Pain intensity

Medication (analgesics)

Recovery (vomiting, pyrexia, digestion, appetite, sleep, bowel function, general recovery, micturition, complications)

Length of procedure

Physiological parameters (blood pressure, heart rate)

Münch & Zug (1990) [65]

Germany

Thyroidectomy

General (comfort and well-being), direct (relaxing and feeling well, no vomiting, no nausea, only little pain); classical music played in a modern fashion

18

Blank tape

18

N

Mental distress (well-being)

Pain intensity

Recovery (PONV)

Length of procedure

Nilsson et al. (2001) [66]

Sweden

Hysterectomy

Relaxing and encouraging; music (relaxing and calming; accompanied by soothing sounds of sea waves)

31

Operation room sounds

28

I

Mental distress (well-being) Pain intensity

Medication (analgesics)

Recovery (nausea, fatigue, mobility)

Length of procedure

Physiological parameters (blood loss)

Oddby-Muhrbeck et al. (1995) [67]

Sweden

Elective breast surgery

Affirmative (safe atmosphere, quick recovery, feelings of hunger and thirst)

35

Low electronic sound set

35

I

Pain intensity

Medication (analgesics)

Recovery (PONV, general recovery)

Length of procedure

Physiological parameters (blood loss)

Pearson (1961) [39]

USA

Thyroidectomy, gastrectomy, hernia repair, hysterectomy, pelvic laparoscopy, vein stripping

In a permissive manner (relaxation and selfresponsibility of the patient for the course of recovery)

43

Blank tape

38

GA

Medication (analgesics)

Recovery (general recovery)

Rosenberg (1992) [68]

USA

Hysterectomy, myomectomy, other gynaecological procedures, cholecystectomy

Positive (smooth, comfortable, and rapid recovery, absence of sickness and pain), procedural/ sensory information about course of surgery and recovery; imagery, recommendations for dealing with postoperative events and sensations

33

Blank tape

32

I

Mental distress (anxiety)

Pain intensity

Medication (analgesics, antiemetics)

Recovery (mobility, pyrexia, micturation)

Length of procedure

Steinberg et al. (1993) [69]

USA

Total abdominal hysterectomy or breast reconstruction by transverse rectus abdominus musculocutaneous reconstruction flap

Positive (relating to nausea and anxiety)

30

Blank tape

30

I

Mental distress (anxiety)

Pain intensity

Medication (analgesics)

Recovery (PONV)

van der Laan et al. (1996) [70]

USA

Hysterectomy, myomectomy, gynecologic laparotomy

Nonspecific affirmative (feelings of relaxation and security)

20

Story of Peter Pan

20

I

Mental distress (anxiety)

Pain intensity

Medication (analgesics)

Recovery (nausea)

Length of procedure

Williams et al. (1994) [42]

UK

Major gynaecological surgery

Positive (smooth and uncomplicated progress of surgery, well-being after surgery, absence of sickness)

22

Blank tape

29

I

Medication (analgesics)

Recovery (PONV, fluid replacement)

Length of procedure

Physiological parameters (blood loss)

Woo et al. (1987) [71]

USA

Hysterectomy

Positive (rapid recovery)

7

Ocean sounds

7

I

Medication (analgesics)