To deliver a 30-minute binaural beats audio intervention in PACU and collect pain and anxiety outcomes immediately following surgery, and 4 hours following surgery completion in adults undergoing ambulatory total knee arthroplasty and total hip arthroplasty (TKA and THA).
American Society of Anesthesiologists Physical Status Classification System (ASA) 1-3
Spinal anesthesia
Patients receiving nerve-block in Post-Anesthesia Care Unit (PACU)
Primary total hip or total knee arthroplasty
Moderate-severe hearing impairment or use of hearing aids
History of significant tinnitus, active delirium, chronic high-dose opioid therapy (>60 MME/day baseline)
Major psychiatric pathology
General anesthesia
Parallel
Binaural Beats Audio Intervention
Other intervention30-minute binaural beats audio session targeting 400 and 410 hertz (Hz) alpha 400 hertz (Hz) in one ear 410 hertz (Hz) in other ear frequency delivered through standardized headphones in the PACU.
Music of Choice
Other interventionUsual postoperative care in addition to patient-selected music using standardized headphones
Change in Pain Score Numeric Pain Rating Scale (NPRS)
Pain intensity will be measured using the Numeric Pain Rating Scale (NPRS), a validated 0-10 scale where 0 = no pain and 10 = worst imaginable pain. Change will be calculated as the difference between the pre-operative NPRS score and the NPRS score obtained 4 hours after surgery. Higher scores indicate greater pain intensity.
Change in Anxiety Score State-Trait Anxiety Inventory (STAI-S)
Anxiety will be measured using the State-Trait Anxiety Inventory - State Subscale (STAI-S). The STAI-S consists of 20 items scored from 1 to 4, producing a total score range of 20-80, with higher scores indicating greater state anxiety. Change will be calculated as the difference between the pre-operative STAI-S score and the STAI-S score obtained 4 hours after surgery.
Total Opioid Consumption in the Post-Anesthesia Care Unit (PACU) (MME)
Total opioid use administered during the post-anesthesia care unit (PACU) stay will be recorded, including all intravenous and oral opioid medications. All doses will be converted to morphine milligram equivalents (MME) using standard Centers for Disease Control and Prevention (CDC) conversion factors. Unit of Measure: Morphine milligram equivalents (MME)
Postoperative Vital Signs Heart Rate
Heart rate (beats per minute) recorded at fixed 30-minute intervals during PACU recovery. Values will be abstracted from the electronic medical record.
Patient Satisfaction Score
Patient satisfaction with the postoperative experience will be measured using a 5-point Likert scale, where 1 = very dissatisfied and 5 = very satisfied. Unit of Measure: Likert score (1-5)
Postoperative Vital Signs Blood Pressure
Systolic and diastolic blood pressure (millimeters of mercury) recorded at fixed 30-minute intervals during PACU recovery. Values will be abstracted from the electronic medical record.
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