1. Introduction
Perioperative anxiety is a common psychological and physiological response experienced by patients undergoing surgical procedures. In ophthalmology, this issue is particularly pronounced because many eye surgeries, including pterygium excision, are performed under local anesthesia, meaning patients remain conscious throughout the procedure. The presence of surgical instruments near the eye and the sensation of manipulation can be distressing, triggering heightened levels of stress and fear
[1]. High levels of anxiety during surgery can stimulate the sympathetic nervous system, resulting in physiological changes such as elevated blood pressure, increased heart rate, and rapid respiration
[2]. These responses not only compromise patient comfort and satisfaction but also pose risks for intraoperative complications, such as movement during delicate procedures. Therefore, managing perioperative anxiety effectively is essential to ensuring both patient safety and procedural success.
Traditional approaches to anxiety management have primarily relied on pharmacologic interventions, including sedatives and anxiolytics. However, these medications are not without risks and may be contraindicated in certain patient populations, such as the elderly or those with comorbid conditions. This has led to growing interest in non-pharmacological, nurse-led strategies to address perioperative anxiety in a safe and holistic manner.
2. Non-Pharmacological Interventions in Nursing Practice
Nursing professionals are at the forefront of perioperative care and are well-equipped to implement interventions aimed at reducing patient anxiety. Non-pharmacological interventions, such as therapeutic communication, music therapy, aromatherapy, guided imagery, and relaxation breathing, have become increasingly integrated into evidence-based nursing practice.
One particularly promising technique is the use of binaural beats—an auditory stimulation method that does not require complex equipment or technical expertise. Unlike pharmacological solutions, which require prescription and monitoring for side effects, auditory interventions can be administered by trained nurses without significant resource investment. This accessibility makes them ideal for high-throughput outpatient surgical environments.
Nursing-led interventions that incorporate binaural beats offer a dual benefit: they address the patient’s psychological needs while reinforcing the nurse–patient relationship through empathy and holistic care. Importantly, these interventions align with the principles of patient-centered care and the holistic nursing model, which emphasize individualized, compassionate approaches to health management. With growing empirical support, nurse-delivered non-pharmacological therapies are now recognized as a critical component in improving surgical experiences and outcomes
[3].
3. Binaural Beats and Their Mechanism of Action
Binaural beats are a form of auditory illusion that occurs when two tones of slightly different frequencies are presented separately to each ear via stereo headphones. The brain perceives a third tone—called the “binaural beat”—that is the mathematical difference between the two original frequencies. For example, if a 200 Hz tone is played in one ear and a 210 Hz tone in the other, the brain perceives a 10 Hz beat.
This 10 Hz frequency corresponds to the alpha brainwave range, which is associated with calmness, meditation, and reduced anxiety
[4]. Conversely, higher frequencies in the beta range (13–30 Hz) are linked to heightened alertness, focus, and sometimes stress. It is hypothesized that binaural beats modulate brain activity through a process known as brainwave entrainment, wherein exposure to certain auditory frequencies leads the brain to synchronize its electrical activity to match the stimulus frequency.
Scientific studies using electroencephalography (EEG) have supported this phenomenon, showing increased alpha activity following exposure to binaural beats in the alpha range. Furthermore, psychological studies have shown that listening to alpha-range binaural beats can reduce subjective anxiety scores and physiological markers of stress. These effects make binaural beats a compelling option for perioperative anxiety management—particularly when integrated into a structured, nurse-led intervention protocol.
4. Research Highlight: Nursing-Led SBB Intervention During Pterygium Surgery
In a Scientific studies using electroencephalography (EEG) have supported this phenomenon, showing increased alpha activity following exposure to binaural beats in the alpha range. Furthermore, psychologrecent randomized controlled trial conducted by Dr. Punchiga Ratanalerdnawee and colleagues, the efficacy of a nursing-led superimposed binaural beat (SBB) intervention was evaluated in patients undergoing pterygium excision surgery. The study was conducted in a clinical setting where patients typically remain conscious under local anesthesia, making anxiety a prevalent challenge.
Participal studies have shown that listening to alpha-rangents were randomized into three groups: one received the SBB intervention (natural ambient music with embedded binaural beats can reduce subjective anxiety scores and physiological markers of stress. These effects make binaural b), one received plain music without binaural beats, and one served as a silent control. The auditory intervention was administered using noise-canceling headphones, and a trained perioperative nurse managed audio playback before and during the surgical procedure.
The
SBB tra
ts a compelling option for perioperative anxiety management—particularly when integrated into a structck was custom-designed and licensed by Chiang Mai University. It began with a 20 Hz frequency (in the beta range) for the first five minutes to promote alertness, gradually decreasing to 10 Hz (alpha range) over the next five minutes to induce relaxation, which was then maintained for the remainder of the procedure
d,[5]. The total listenin
urse-led intervention protocolg duration extended up to 60 minutes, including a short postoperative phase.
4. Research Highlight: Nursing-Led SBB Intervention During Pterygium Surgery
In a recent randomized controlled trial conducted by Dr. Punchiga Ratanalerdnawee and colleagues, the efficacy of a nursing-led superimposed binaural beat (SBB) intervention was evaluated in patients undergoing pterygium excision surgery. The study was conducted in a clinical setting where patients typically remain conscious under local anesthesia, making anxiety a prevalent challenge.
Participants were randomized into three groups: one received the SBB intervention (natural ambient music with embedded binaural beats), one received plain music without binaural beats, and one served as a silent control. The auditory intervention was administered using noise-canceling headphones, and a trained perioperative nurse managed audio playback before and during the surgical procedure.
study found The SBB track was custom-designed and licensed by Chiang Mai University. It began with a 20 Hz frequency (in the beta range) for the first five minutes to promote alertness, gradually decreasing to 10 Hz (alpha range) over the next five minutes to induce relaxation, which was then maintained for the remainder of the procedure[5]. The total listening duration extended up to 60 minutes, including a short postoperative phase.
The study found that the hat the SBB group experienced a significantly greater reduction in state anxiety scores (STAI-S) compared to both the plain music and control groups. Additionally, objective physiological parameters—including systolic blood pressure, heart rate, and respiratory rate—improved significantly in the SBB group. Notably, patient satisfaction scores were also higher, and no adverse events were reported. These findings demonstrate the practical utility, safety, and effectiveness of nursing-led auditory interventions in ophthalmic surgical care.
5. Implications for Nursing Practice
The integration of SBB interventions into perioperative nursing care highlights the potential for low-cost, scalable strategies to enhance patient outcomes. This approach empowers nurses to address psychological distress without relying on medications, aligning with contemporary models of holistic, patient-centered care.
From an operational perspective, the SBB protocol is simple to implement: it requires only a stereo audio device, pre-loaded tracks, and a short nurse-led briefing. Given the growing emphasis on patient satisfaction as a key performance metric in healthcare systems, such non-invasive interventions can meaningfully improve perceived quality of care and clinical efficiency.
Moreover, the nurse’s role as both caregiver and facilitator of comfort reinforces the trust dynamic central to positive surgical experiences. By proactively managing anxiety through sensory modulation, nurses can help stabilize patient physiology, reduce intraoperative complications, and contribute to smoother recoveries. Training nursing staff in auditory-based anxiolytic methods could thus be an important direction for continuing education and institutional quality improvement.
Moreover, the nurse’s role as both caregiver and facilitator of comfort reinforces the trust dynamic central to positive surgical experiences. By proactively managing anxiety through sensory modulation, nurses can help stabilize patient physiology, reduce intraoperative complications, and contribute to smoother recoveries. Training nursing staff in auditory-based anxiolytic methods could thus be an important direction for continuing education and institutional quality improvement.
6. Conclusion
Nurse-led binaural beat therapy represents a novel, evidence-based strategy for perioperative anxiety management. Its application during pterygium surgery has demonstrated significant improvements in both psychological and physiological outcomes. As a non-pharmacological, patient-friendly intervention, SBB has the potential to become a standard adjunct in ophthalmic nursing care and beyond.
Future research should explore the broader applicability of SBB across surgical specialties, its long-term effects on recovery, and validation through EEG-based brainwave monitoring. Nonetheless, the current evidence supports the integration of this simple yet effective tool into nursing protocols—reinforcing the vital role of nurses in advancing patient-centered innovations.
