Abstract
Objective:
This study aimed to investigate the association between the level of environmental noise exposure in the postanesthesia care unit (PACU) during emergency from anesthesia and postoperative acute pain in patients undergoing hip arthroplasty under general anesthesia.
Methods:
This study was a single-center retrospective study that included 100 patients who underwent elective hip arthroplasty under general anesthesia in Xuzhou No.1 People’s Hospital from January 2023 to December 2025; all patients were admitted to the PACU after surgery to complete the standard emergency process. The patients were divided into low-noise group (≤52 dB[A], medium-noise group (53–58 dB[A], and high-noise group (≥59 dB[A] according to the noise exposure tripartite. The PACU immediate numeric rating scale (NRS) score was used as the primary outcome measure, and a multiple linear regression model was used to analyze the relationship between noise exposure and pain score, adjusting for potential confounders.
Results:
No significant differences were observed in baseline demographic characteristics and perioperative indicators between the three groups (all P > 0.05). There was a statistically significant difference in the postoperative acute pain NRS scores among patient subgroups with different levels of environmental noise exposure in the PACU (P = 0.002). After adjusting for confounding factors, multiple linear regression analysis showed that PACU environmental noise exposure was significantly positively correlated with postoperative acute pain scores, with an average increase of 0.07-points (95% CI: 0.03–0.11, P < 0.001) for every 1 dB(A) increase in noise level. The association remained stable after correcting for confounders, showing a clear dose–response relationship.
Conclusion:
The level of PACU environmental noise exposure is significantly correlated with acute postoperative pain severity in patients undergoing hip arthroplasty under general anesthesia. This study provides clinical evidence for the health effects of the hospital acoustic environment; it can help improve patients’ perioperative experience and quality of rehabilitation.
Keywords: noise, acoustic environment, recovery room, postoperative pain
KEY MESSAGES
-
(1)
This study explores the association between environmental noise and postoperative acute pain in hip arthroplasty patients under general anesthesia.
-
(2)
The noise level (LAeq) is positively correlated with the postoperative numeric rating scale (NRS) score; each 1 dB(A) increase is associated with a 0.07-point increase in the NRS score rise after adjusting for confounders.
-
(3)
These findings provide clinical evidence that optimizing noise control can improve patients’ perioperative pain experience and promote early rehabilitation.
INTRODUCTION
Hip arthroplasty is an effective surgical method for the treatment of end-stage hip diseases (e.g., femoral head necrosis, hip arthritis), which can markedly improve joint function and quality of life in patients.[1] After surgery, the patient needs to be transferred to the postanesthesia care unit (PACU) for centralized monitoring and resuscitation intervention. Postoperative acute pain is one of the most prevalent distressing symptoms for patients in the PACU, which not only triggers negative emotions such as anxiety and irritability but may also induce cardiovascular stress response, delay the recovery of gastrointestinal function, and even increase the risk of transition to chronic pain, seriously affecting the patient’s perioperative experience and recovery.[2,3]
As a ubiquitous nonphysiological stressor, hospital environmental noise has been listed by the World Health Organization as an important factor affecting hospital environmental quality and patient health.[4] Long-term or high-level noise exposure can have many adverse effects on human physiology and psychology, including inducing sympathetic excitation, increasing cortisol levels, interfering with sleep and rest, and exacerbating negative emotions.[5] Studies have shown that environmental noise exposure in intensive care units and general wards is closely related to patients’ pain perception and anxiety levels. However, there is still a lack of research on the specific PACU setting.[6,7]
As a key place for patients to emerge from anesthesia to wakefulness, the quality of the acoustic environment in PACU has special characteristics: on the one hand, medical equipment is dense in PACU, and high-frequency noises such as monitor alarms, ventilator airflow and sputum suction sound persist; on the other hand, medical staff need to frequently monitor vital signs, adjust patient positioning, and administer intravenous fluids and medications to ensure patient safety, and related communication and operational noise will also increase the environmental noise load.[8] Because patients in PACU are in the special physiological state during emergency from anesthesia, the sensitivity of their pain regulation system may be altered, and environmental noise, as an external stress stimulus, may amplify pain perception signals by activating the hypothalamic–pituitary–adrenal axis and inducing emotional arousal, thereby aggravating acute postoperative pain.[9]
At present, there is no consensus on the association between PACU environmental noise exposure and postoperative acute pain. A previous study found that noise exposure was not markedly associated with pain scores, which may be due to sample size, the duration of noise monitoring, and insufficient control of confounding factors.[10] In addition, there is a study specifically on patients undergoing hip arthroplasty, who have higher postoperative pain intensity and are mostly middle-aged and elderly; their tolerance to noise stimuli may be lower, and the association between PACU noise exposure and pain perception may be different.[11] Therefore, this retrospective study aimed to explore the relationship between PACU environmental noise exposure level and postoperative acute pain in patients after hip arthroplasty under general anesthesia, to provide clinical evidence and a practical basis for optimizing PACU environmental management and improving patients’ postoperative pain experience.
MATERIALS AND METHODS
Research Objects
This single-center retrospective study included patients who underwent elective hip arthroplasty (including total hip arthroplasty and hemihip arthroplasty) under general anesthesia in the Department of Anaesthesiology of Xuzhou No. 1 People’s Hospital from January 2023 to December 2025. A total of 167 patients undergoing hip replacement surgery were evaluated for eligibility. Among them, 27 cases were excluded due to a history of pain, and 40 were excluded due to incomplete data. The main causes of missing data were as follows: 23 cases had missing noise exposure indicators caused by malfunction, nonactivation or abnormal data export of PACU noise monitoring equipment; 17 cases failed to complete exposure‑outcome matching due to nonstandard documentation of NRS pain scores at key postoperative time points. All missing data resulted from objective factors, and no patients were selectively excluded based on study outcomes, thereby reducing selection bias to some extent. Finally, 100 cases were included in the final analysis. The inclusion criteria were as follows: (1) age ≥18 years, no gender restriction; (2) clearly diagnosed with hip joint disease, requiring elective hip arthroplasty with a clear surgical procedure; (3) general anesthesia was used and successfully transferred to the PACU for emergence monitoring after surgery; and (4) clinical data (including demographic characteristics, perioperative indicators, noise monitoring data, pain scores) were complete and traceable. The exclusion criteria were as follows: (1) history of chronic pain (such as lumbar disc herniation, chronic pain caused by rheumatoid arthritis) or long-term use of analgesic drugs; (2) presence of severe dysfunction of vital organs such as heart, liver, kidney, or brain; (3) mental illness, cognitive dysfunction or inability to cooperate with pain scores; (4) development of serious complications after surgery (such as heavy bleeding, infection, pulmonary embolism) requiring urgent intervention; or (5) PACU stay <30 min or missing noise monitoring data.
According to the above criteria, 100 patients were finally included: 47 males and 53 females; age 45–78 years, average (62.35 ± 8.52) years; body mass index (BMI) 18.5–28.6 kg/m2, average (23.71 ± 2.42) kg/m2; 68 cases of total hip arthroplasty and 32 cases of hemihip arthroplasty; operation time was 60–150 min, with an average of (98.55 ± 21.31) min.
This study was approved by the Ethics Committee of Xuzhou No. 1 People’s Hospital (ethics number: xyyll [2026]051), and all patients agreed to the treatment and signed the informed consent form. As this study involved human participants, it was conducted in accordance with the Declaration of Helsinki by the World Medical Association.[12]
Research Methods
Intraoperative Anesthetic Usage
Standardized combined intravenous-inhalation general anesthesia was administered to all subjects.
Patients were intravenously administered 0.15 mg/kg remimazolam (National Medical Product Approval No. H20200006, Yichang Humanwell Pharmaceutical Co., Ltd.) with an injection duration of 1 min, or 0.3–0.4 mg/kg ciprofol (National Medical Product Approval No. H20200013, Shenyang Haisco Pharmaceutical Co., Ltd.), 0.15–0.2 mg/kg Cisatracurium Besilate, 0.15–0.20 µg/kg Sufentanil (National Medical Product Approval No. H20203653, Jiangsu Nhwa Pharmaceutical Co., Ltd.). After successful anesthesia induction, endotracheal intubation was performed, and the patient was connected to an anesthesia machine. Meanwhile, continuous infusion of 0.02–0.03 mg/(kg · h) Remifentanil and 0.4 mg/(kg · h) Ciprofol was administered. Cisatracurium Besilate at a dose of 0.1 mg/kg was intravenously injected every 0.5 h until the end of the operation.
Anesthetics were discontinued 30 min before the end of surgery. No additional analgesics were administered during PACU stay.
PACU Environmental Noise Monitoring
The PACU was a standardized care unit with an area of about 100 m2, equipped with 10 monitoring beds, conventional monitoring equipment (multiparameter monitor, electrocardiograph, blood pressure monitor), respiratory support equipment (ventilator, simple respirator), first aid equipment and drug infusion equipment. The noise monitoring system (model: DLX-2205, Delixi Group Co., Ltd., China) uniformly equipped by the hospital was used for noise data collection, which is calibrated and qualified, with a measurement range of 30–130 dB(A) and an accuracy of ± 1 dB(A), which meets the requirements of GBZ/T 189.8-2007 “Noise measurement of physical factors in the workplace.”[13]
The noise monitoring point was set 50 cm above the patient’s bedside (1.2 m from the ground) and was positioned to avoid obstruction by medical equipment and other objects to ensure the accuracy of the monitoring data. The monitoring period started from immediately after the patient was transferred to the PACU and lasted for 30 min. The equivalent continuous A-weighted sound pressure level (LAeq, dB[A] was continuously monitored and automatically recorded. LAeq refers to the steady sound pressure level equivalent to the noise energy over a period after filtering the irregular noise signal through the A-weighted network, which objectively reflects the average exposure level of environmental noise. In this study, the average LAeq value during the first 30 min after PACU admission was used as an individual noise-exposure index.
According to the tertiles of PACU noise exposure levels of all patients, the patients were divided into three groups: low noise group (LAeq ≤52 dB[A], medium noise group (LAeq 53–58 dB[A], and high noise group (LAeq ≥59 dB[A], with 33, 34, and 33 patients in each group, respectively.
Postoperative Acute Pain Assessment
The primary outcome was the level of acute postoperative pain measured immediately after the patient’s arrival in the PACU, which was assessed using a numeric rating scale (NRS).[14] The NRS score ranged from 0 to 10 points, with 0 points indicating no pain, 1–3 mild pain, 4–6 moderate pain, and 7–10 severe pain. After the patient was fully conscious and had stable vital signs, the patient remained undisturbed and stable for 10–15 min to allow residual sedative effects to subside and pain perception to normalize before the initial assessment of acute pain. “Fully awake” was standardized using the Steward Awakening Score ≥4 to reduce assessment bias and improve the reliability of the results. The patient was asked, “regarding the current pain level in the hip area, please choose a score from 0 to 10 points that best represents your pain sensation,” and the score was accurately recorded. If the patient was temporarily unable to express themselves clearly, the evaluation was performed after the patient was fully conscious to ensure the reliability of the score. This scale has good reliability and validity, with a test–retest reliability ICC = 0.95 and internal consistency Cronbach’s α = 0.91; its criterion validity shows a correlation coefficient r = 0.94 with VAS, making it a recognized and reliable tool for clinical postoperative pain assessment.
Collection of Confounding Factors
Based on previous relevant studies,[15,16] potential confounding factors that may affect postoperative acute pain were screened, and relevant information was extracted through the hospital’s electronic medical record system, including (1) demographic characteristics: age, gender, BMI; (2) perioperative indicators: operation time (time from surgical skin incision to suture completion); and (3) postoperative analgesic regimen: divided into three categories: intravenous self-controlled analgesia (PCA), oral analgesic drugs and intramuscular analgesics.
Statistical Methods
SPSS 26.0 statistical software (IBM Corporation, Armonk, NY, USA) was used for data processing and analysis. Normality of the measurement data was assessed using the Shapiro–Wilk test combined with Q–Q normal probability plots. Mean ± standard deviation (x̄±s) was expressed as mean data, and one-way analysis of variance (ANOVA) was used for between-group comparisons, and Welch’s correction test was used for uneven variance. The LSD-t test was used for pairwise comparisons between groups when the variances were homogeneous. Statistical data were expressed as cases (percentages) (n [%], and between-group comparisons were made using the χ2 test or Fisher’s exact probability method. A multiple linear regression model was used to analyze the association between PACU environmental noise exposure level (LAeq) and postoperative acute pain NRS score. An uncorrected model was constructed, and according to clinical expertise and previous relevant literature, factors that may affect the occurrence and intensity of postoperative acute pain were selected as confounding variables, including age, gender, BMI, duration of surgery, and postoperative analgesia protocol, and the regression coefficient (β) and 95% confidence interval (95% CI) and P value. A P < 0.05 was considered statistically significant.
RESULTS
Comparison of Baseline Data and Perioperative Indicators of the Three Groups
There were no significant differences in baseline data and perioperative indicators such as age, gender, BMI, ASA grade, type of surgery, duration of surgery, and postoperative analgesia regimen among the three groups (all P > 0.05), suggesting that the patients in the three groups were comparable [Table 1].
Table 1.
Comparison of Baseline Data and Perioperative Indicators
| Indicators | Low-Noise Group (n = 33) | Medium-Noise Group (n = 34) | High-Noise Group (n = 33) | Statistics | P |
|---|---|---|---|---|---|
| Age (years),x̄±s | 61.82 ± 8.91 | 62.52 ± 8.21 | 62.63 ± 8.73 | F = 0.082 | 0.921 |
| Gender, n (%) | χ2 = 0.175 | 0.916 | |||
| Male | 15(45.5) | 16(47.1) | 16(48.5) | ||
| Female | 18(54.5) | 18(52.9) | 17(51.5) | ||
| BMI (kg/m2), x̄±s | 23.51 ± 2.55 | 23.84 ± 2.32 | 23.92 ± 2.41 | F = 0.145 | 0.865 |
| ASA grade, n (%) | χ2 = 0.352 | 0.839 | |||
| Level I–II | 22(66.7) | 23(67.6) | 21(63.6) | ||
| Grade III–IV | 11(33.3) | 11(32.4) | 12(36.4) | ||
| Type of surgery, n (%) | χ2 = 0.098 | 0.952 | |||
| Total hip arthroplasty | 22(66.7) | 23(67.6) | 23(69.7) | ||
| Hemihip replacement | 11(33.3) | 11(32.4) | 10(30.3) | ||
| Duration of surgery (min), x̄±s | 97.83 ± 20.91 | 99.23 ± 21.54 | 98.56 ± 21.72 | F = 0.028 | 0.972 |
| Average postoperative recovery time (min) x̄±s | 17.23 ± 2.45 | 18.21 ± 3.32 | 17.43 ± 2.87 | F = 1.068 | 0.348 |
| Average time interval for the first assessment after regaining consciousness (min) x̄±s | 12.15 ± 2.81 | 11.69 ± 1.82 | 11.82 ± 2.54 | F = 0.320 | 0.727 |
| Postoperative analgesia regimen, n (%) | χ2 = 0.587 | 0.746 | |||
| Intravenous self-controlled analgesia | 18(54.5) | 17(50.0) | 16(48.5) | ||
| Oral analgesics | 8(24.2) | 10(29.4) | 9(27.3) | ||
| Intramuscular analgesic medications | 7(21.2) | 7(20.6) | 8(24.2) |
Note: BMI is body mass index; ASA is the American Society of Anesthesiologists; One-way analysis of variance or χ2 test was used for comparison between groups.
Comparison of the NRS Scores of Immediate Postoperative Acute Pain in the PACU of the Three Groups
The results of ANOVA showed a statistically significant difference in the immediate PACU NRS score among the three groups (F = 10.562, P = 0.002). There was a statistically significant difference in the postoperative acute pain NRS scores across patient subgroups with different levels of environmental noise exposure in the PACU: the low noise group had an NRS score of 3.23 ± 1.12, the medium noise group was 3.83 ± 1.22, and the high noise group was 4.66 ± 1.35. The results of the comparison showed that the NRS score of the high noise group was significantly higher than that of the low noise group (P < 0.001) and the medium noise group (P = 0.015), and the NRS score of the medium noise group was significantly higher than that of the low noise group (P = 0.042, Table 2).
Table 2.
Comparison of Postoperative NRS Scores of the Three Groups
| Grouping | n | NRS score | F | P |
|---|---|---|---|---|
| Low-noise group | 33 | 3.23 ± 1.12 | 10.562 | 0.002 |
| Medium-noise group | 34 | 3.83 ± 1.22* | ||
| High-noise group | 33 | 4.66 ± 1.35*# |
Note: *P < 0.05 compared to the low noise group, #P < 0.05 compared to the medium noise group.
Multiple Linear Regression Analysis of PACU Environmental Noise Exposure and Postoperative Acute Pain NRS Score
A multiple linear regression model was constructed to analyze the association between the two by using PACU environmental noise exposure level (LAeq, dB[A] as the independent variable and PACU immediate NRS score as the dependent variable [Table 3]. The results of the uncorrected model showed that PACU environmental noise exposure was significantly positively correlated with the postoperative acute pain NRS score; each 1 dB(A) increase in noise level was associated with a 0.08-point increase in the NRS score (95% CI: 0.04–0.12, P < 0.001). After adjusting for confounding factors, the positive correlation remained stable, with each 1 dB(A) increase in noise level associated with an average 0.07-point increase in the NRS score (95% CI: 0.03–0.11, P < 0.001). It suggests that PACU environmental noise exposure is an independent influencing factor for acute postoperative pain, and a clear dose–response relationship is presented.
Table 3.
Analysis of Multiple Linear Regression Models
| Model | Independent Variables | Regression Coefficient (β) | Standard Error | 95% CI | P | R 2 |
|---|---|---|---|---|---|---|
| Un-calibrated Model | LAeq(dB[A]) | 0.08 | 0.015 | 0.04–0.12 | <0.001 | 0.289 |
| Calibrated Model | LAeq(dB[A]) | 0.07 | 0.016 | 0.03–0.11 | <0.001 | 0.326 |
Note: The calibration model corrected for confounding factors such as age, gender, BMI, operation duration, and postoperative analgesia regimen. LAeq is the equivalent continuous A-weighted sound pressure level.
DISCUSSION
As a key place for patients to emerge from anesthesia, the effect of the PACU’s acoustic environment on patients’ postoperative recovery has gradually attracted attention. However, the relevant clinical evidence is still limited.[17] This study focused on hip replacement, a specific type of surgery that is associated with higher postoperative pain intensity and predominantly involves middle-aged and elderly patients who have weaker physical regulation and lower tolerance to environmental stimuli, so the association between PACU noise exposure and pain perception may be more significant. In this study, the immediate PACU NRS scores of the low, medium, and high noise groups, which was consistent with the results of a previous study.[18] Elevated PACU environmental noise exposure was associated with significantly higher postoperative acute pain scores in patients undergoing abdominal surgery.[19] The effects of persistent, steady low-level background noise in the PACU on the human body are latent and cumulative. However, some studies have come to different conclusions; a previous study suggested that PACU noise exposure is not significantly associated with postoperative pain, which may be related to confounding factors such as the small sample size (n = 60), short noise monitoring duration (only 10 min), and inadequate control of postoperative analgesia regimen,[10] while this study expanded the sample size and extended the noise monitoring duration (30 min). The relevant confounding factors were strictly corrected, and the results were more reliable.
The mechanism of PACU environmental noise exacerbating acute postoperative pain is not fully understood, but it is speculated to be related to the following aspects: First, noise, as an external stress stimulus, can induce sympathetic nervous system activation, leading to increased secretion of stress hormones such as adrenaline and cortisol in the body, and increased stress hormone levels activate pain conduction pathways and amplify pain perception signals, thereby aggravating the patient’s pain perception.[20] Second, patients in PACU are in a special emerging state, consciousness is not fully awake, sleep and rest are severely disturbed, and sleep deprivation or rest disorders will reduce the body’s pain tolerance and make the patient more sensitive to pain stimuli.[21] Third, noise may trigger negative emotions such as anxiety, irritability, and fear, which are closely related to pain perception and can further exacerbate pain experience through psychological stress responses.[22] In addition, the noise in the PACU is mostly irregular and sudden noises (such as monitor alarms and sputum suction sounds), which are more obvious to the human body and can directly stimulate the auditory center and affect the pain modulation system through nerve reflexes, thereby aggravating acute postoperative pain.[23]
Based on the results of this study, it is recommended to incorporate PACU environmental noise control into the hospital quality improvement system and adopt targeted noise control measures: on the one hand, optimize the spatial layout of PACU, place medical equipment reasonably, and reduce mutual interference of equipment operation noise; on the other hand, standardize the operation procedures of medical staff, reduce operating noise (such as handling medical items gently, avoid loud conversations), and reasonably set the alarm threshold of monitoring equipment to reduce unnecessary alarm noise.[24] In addition, patients’ perception of environmental noise can be reduced by providing earplugs or playing soothing music, thereby mitigating the effect of noise on pain perception and improving the patient’s perioperative experience and quality of rehabilitation.
This study has several limitations. First, it is a single-center retrospective study. The preoperative baseline hearing thresholds of patients were not systematically assessed, so the confounding effect of hearing level on the noise–pain relationship could not be adjusted for. Moreover, the noise level in this study was below the high-intensity threshold of 70 dB, so the results are applicable only to moderate-to-high daily noise environments in the PACU. Second, noise monitoring only focused on the average noise level in the first 30 min after PACU admission, without considering the frequency distribution of noise and the effect of sudden noise and did not monitor the patient’s noise exposure during the PACU stay, which may have introduced some measurement bias. Third, this study only used the sound pressure level index and did not include sound quality parameters such as sharpness and roughness. Due to limitations of the on‑site monitoring equipment, sound pressure level data with different frequency weightings could not be obtained, making it impossible to further analyses the effect of noise frequency types. Further in-depth research can combine psychoacoustic indicators to further investigate the adverse effects of low-decibel noise. Fourth, despite correcting for a variety of potential confounders, unidentified confounders (such as the patient’s preoperative pain threshold, psychological state) may still exist and could have a certain effect on the research results.
CONCLUSION
In patients undergoing hip arthroplasty under general anesthesia, the level of PACU environmental noise exposure during emergence from anesthesia is significantly positively correlated with the degree of acute postoperative pain, showing a clear dose–response relationship. Sub-high intensity environmental noise may be detrimental to early postoperative recovery by amplifying pain perception. This study provides new clinical evidence for the health effects of hospital acoustic environment, suggesting that incorporating noise control and acoustic landscape optimization into PACU environmental management strategies may help improve patients’ perioperative pain experience and improve the quality of rehabilitation.
Availability of Data and Materials
The datasets used and analyzed during the current study were available from the corresponding author on reasonable request.
Author Contributions
You Lv and Su Liu designed this study. You Lv and Su Liu undertook manuscript writing and reference checking and sorting. XiaoQing Shao oversaw data collection and data analysis. NingNing Ji was responsible for consulting references and formulating a research plan. XingDui Ma was responsible for manuscript revision and ethical application. All authors contributed to the critical revision of the manuscript for important intellectual content. All authors gave final approval of the version to be published. All authors participated fully in the work, took public responsibility for appropriate portions of the content, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or completeness of any part of the work were appropriately investigated and resolved.
Ethics Approval and Consent to Participate
This study was approved by the Ethics Committee of Xuzhou No.1 People’s Hospital (ethics number: xyyll [2026]051), and all patients agreed to the treatment and signed the informed consent form.
Conflicts of Interest
There are no conflicts of interest in this article.
Acknowledgment
No.
Funding Statement
No.
REFERENCES
- 1.The Joint Surgery Branch of the Chinese Orthopaedic Association, 920th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army. Chinese clinical practice guidelines for total hip arthroplasty approach selection (2021 edition) Chin J Joint Surg (Electronic Edition) 2021;15:651–9. [Google Scholar]
- 2.Alghamdi L, Filfilan R, Alghamdi A, Alharbi R, Kayal H. Factors associated with prolonged-stay patients within the post-anesthesia care unit: a cohort retrospective study. Cureus. 2024;16:e60092. doi: 10.7759/cureus.60092. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Wu T, Qi H, Hui K, et al. Effect of noise isolation with noise-cancelling earmuffs during laparoscopic surgery on acute postoperative pain: a clinical randomised controlled trial. BMC Anesthesiol. 2025;25:498. doi: 10.1186/s12871-025-03369-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.World Health Organization. Guidelines for Community Noise. Geneva: WHO; 1999. [Google Scholar]
- 5.Sonoda N, Furuki H, Morimoto A. Impact of environmental noise on inpatient outcomes: a scoping review. Worldviews Evid Based Nurs. 2025;22:e70056. doi: 10.1111/wvn.70056. [DOI] [PubMed] [Google Scholar]
- 6.Obanor OO, McBroom MM, Elia JM, et al. The impact of earplugs and eye masks on sleep quality in surgical ICU patients at risk for frequent awakenings. Crit Care Med. 2021;49:e822–32. doi: 10.1097/CCM.0000000000005031. [DOI] [PubMed] [Google Scholar]
- 7.Chen Y, Wang S, Fang Q, et al. Impact of noise exposure during emergence on acute pain after orthopedic surgery: a prospective observational study. Int J Nurs Stud. 2025;172:105223. doi: 10.1016/j.ijnurstu.2025.105223. [DOI] [PubMed] [Google Scholar]
- 8.Zhou T, Wu Y, Meng Q, Kang J. Influence of the acoustic environment in hospital wards on patient physiological and psychological indices. Front Psychol. 2020;11:1600. doi: 10.3389/fpsyg.2020.01600. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Donauer K, Bomberg H, Wagenpfeil S, Volk T, Meissner W, Wolf A. Regional vs. general anesthesia for total knee and hip replacement: an analysis of postoperative pain perception from the International PAIN OUT Registry. Pain Pract. 2018;18:1036–47. doi: 10.1111/papr.12708. [DOI] [PubMed] [Google Scholar]
- 10.Ou W, Tao C, Zhang Y, et al. Effects of postoperative environmental noise on surgery induced pain: evidence based on a prospective observational study. Gen Hosp Psychiatry. 2024;88:61–7. doi: 10.1016/j.genhosppsych.2024.03.002. [DOI] [PubMed] [Google Scholar]
- 11.Passias BJ, Johnson DB, Schuette HB, et al. Preemptive multimodal analgesia and post-operative pain outcomes in total hip and total knee arthroplasty. Arch Orthop Trauma Surg. 2023;143:2401–7. doi: 10.1007/s00402-022-04450-0. [DOI] [PubMed] [Google Scholar]
- 12.World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human participants. JAMA. 2025;333:71–4. doi: 10.1001/jama.2024.21972. [DOI] [PubMed] [Google Scholar]
- 13.Ministry of Health of the People’s Republic of China. GBZ/T 189.8–2007 Measurement of physical agents in the workplace, Part 8: Noise. Beijing: Standards Press of China; 2007. [Google Scholar]
- 14.Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37:378–81. doi: 10.1136/ard.37.4.378. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Jurewicz A, Gasiorowska A, Leźnicka K, et al. Individual factors modifying postoperative pain management in elective total hip and total knee replacement surgery. Life (Basel) 2024;14:211. doi: 10.3390/life14020211. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Wu F, Liu J, Zheng L, et al. Preoperative pain sensitivity and its correlation with postoperative acute and chronic pain: a systematic review and meta-analysis. Br J Anaesth. 2024;133:591–604. doi: 10.1016/j.bja.2024.05.010. [DOI] [PubMed] [Google Scholar]
- 17.You S, Xu F, Wu Y, et al. Effect of noise isolation using noise-cancelling headphones during laparoscopic surgery for postoperative pain reduction: a randomized clinical trial. J Clin Anesth. 2024;92:111286. doi: 10.1016/j.jclinane.2023.111286. [DOI] [PubMed] [Google Scholar]
- 18.Zhang H, Li J, Wang Y. Effect of PACU noise exposure on postoperative pain in patients undergoing orthopedic surgery. J Pain Res. 2022;15:2895–903. [Google Scholar]
- 19.Zhang Q, Wang L. Correlation between environmental noise and postoperative acute pain in PACU patients. Br J Anaesth. 2021;127:i123–4. [Google Scholar]
- 20.Colebaugh CA, Wilson JM, Flowers KM, et al. The impact of varied music applications on pain perception and situational pain catastrophizing. J Pain. 2023;24:1181–92. doi: 10.1016/j.jpain.2023.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Chang JR, Fu SN, Li X, et al. The differential effects of sleep deprivation on pain perception in individuals with or without chronic pain: a systematic review and meta-analysis. Sleep Med Rev. 2022;66:101695. doi: 10.1016/j.smrv.2022.101695. [DOI] [PubMed] [Google Scholar]
- 22.Sobol-Kwapinska M, Bąbel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: a systematic review and meta-analysis. Eur J Pain. 2016;20:1573–86. doi: 10.1002/ejp.886. [DOI] [PubMed] [Google Scholar]
- 23.Li X, Yao J, Lin X, Chen S, Jin R, Peng W. Transcranial random noise stimulation over the left dorsolateral prefrontal cortex attenuates pain expectation and perception. Clin Neurophysiol. 2023;147:1–10. doi: 10.1016/j.clinph.2022.12.009. [DOI] [PubMed] [Google Scholar]
- 24.Chinese Society of Anesthesiology. Chinese Medical Association. Expert consensus on post-anesthesia care. J Clin Anesthesiol. 2021;37:89–94. Chinese. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and analyzed during the current study were available from the corresponding author on reasonable request.