Authors: Stoop J M et al.
Anesthesia & Analgesia, 142(4):625–634, April 2026
This systematic review and meta-analysis evaluated the effectiveness of music as a perioperative intervention for anxiety and translated its impact into a clinically intuitive metric—the number needed to treat (NNT).
Perioperative anxiety is extremely common and has meaningful physiologic and recovery implications. While pharmacologic treatments such as benzodiazepines are effective, they carry risks including sedation, respiratory depression, and postoperative delirium. This study aimed to quantify how effective music therapy is in comparison using a standardized and practical measure.
The authors analyzed 20 randomized controlled trials assessing music interventions in surgical patients. Anxiety was measured using validated tools such as the Visual Analog Scale for Anxiety and the State-Trait Anxiety Index. The pooled results demonstrated a moderate-to-large reduction in anxiety, with a standardized mean difference of −0.72.
Using this effect size, the authors calculated a number needed to treat of 4. This means that for every four patients exposed to perioperative music, one patient experiences a clinically meaningful reduction in anxiety. In practical terms, this corresponded to a reduction of approximately 12 mm on a visual analog scale or 5.7 points on the State-Trait Anxiety Index.
What makes this finding particularly compelling is that the magnitude of benefit is comparable to benzodiazepines, but without the associated side effects. Music is noninvasive, inexpensive, easy to implement, and carries essentially no risk. Despite this, it remains underutilized in routine perioperative care.
The study reinforces the growing body of evidence supporting nonpharmacologic interventions as part of multimodal perioperative management. While variability exists in how music was delivered across studies (timing, type, patient choice), the consistent signal across trials supports its general effectiveness.
Limitations include heterogeneity in study design, patient populations, and music protocols. Additionally, the subjective nature of anxiety measurement introduces variability. However, the consistency of benefit across multiple trials strengthens the overall conclusion.
Key Points
- Music intervention significantly reduces perioperative anxiety
- Effect size is moderate-to-large (standardized mean difference −0.72)
- Number needed to treat is 4, indicating strong clinical effectiveness
- Comparable efficacy to benzodiazepines without associated risks
- Low-cost, noninvasive intervention that is easy to implement
What You Should Know
This is one of the clearest arguments yet for using music as a routine part of perioperative care. An NNT of 4 is impressive for any intervention—especially one that is safe, inexpensive, and simple. If something had drug-level efficacy with zero side effects, we would use it automatically. This study suggests music should be treated that way. The barrier is not evidence—it is adoption.
We want to thank Anesthesia & Analgesia for allowing us to summarize and share this important work with the anesthesia community.