Abstract
BACKGROUND: Perioperative anxiety and discomfort are common in orthopaedic fracture surgery under regional anaesthesia. Music therapy, a nonpharmacological intervention, may reduce anxiety and improve patient experience; however, its role in this context is underexplored. METHODS: This retrospective cohort study evaluated 240 adults undergoing elective closed limb fracture surgery under regional anaesthesia (January 2023-December 2024). The patients were divided into a Music group (n = 120) receiving perioperative music via headphones and a Control group (n = 120) receiving standard care. Outcomes included preoperative anxiety (State-Trait Anxiety Inventory - State scale [STAI-S]), postoperative pain (Visual Analogue scale), sedative/opioid use (midazolam, fentanyl), vital signs, satisfaction and complications. RESULTS: The following baseline characteristics were similar for the two groups: age (48.3 ± 13.9 vs. 49.4 ± 15.5 years), gender (55% male vs. 49.2% female), American Society of Anesthesiologists (ASA) status (19.2% vs. 19.2% ASA I, 60.0% vs. 64.2% ASA II, 20.8% vs. 16.7% ASA III). Compared with those in the Control group, postoperative anxiety scores (STAI-S) were lower in the Music group 2 hours after surgery (39.5 ± 7.8 vs. 48.2 ± 9.1, P < 0.01). Their postoperative pain scores were also reduced (2.9 ± 0.9 vs. 4.3 ± 1.3, P < 0.01). The Music group required less midazolam (0.03 ± 0.01 vs. 0.04 ± 0.01 mg/kg) and fentanyl (0.4 ± 0.2 vs. 0.6 ± 0.2 μg/kg; both P < 0.01) and had higher satisfaction (8.4 ± 0.7 vs. 7.2 ± 1.0, P < 0.01). Complication rates were similar (5.0% vs. 6.7%, P = 0.56). CONCLUSIONS: Perioperative music therapy reduced anxiety, pain and sedative/opioid use whilst improving satisfaction in orthopaedic surgery under regional anaesthesia. Music is a safe, low-cost adjunct to enhance perioperative care in awake surgical settings.