Binaural beats for perioperative anxiety and pain: A systematic review and meta-analysis

Perioperative anxiety has a high prevalence, exacerbating hemodynamic fluctuations and postoperative pain. Compared with conventional music therapy, binaural beats (BB) audio distinctively modulates emotional pathways via cortical entrainment, potentially offering superior anxiolytic and analgesic efficacy in surgical settings.

This meta-analysis aimed to evaluate the effects of BB audio on perioperative anxiety, pain, and hemodynamic parameters in patients undergoing surgical procedures.

Randomized controlled trials (RCTs) published from database inception to December 2024 were retrieved from MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Studies examining the effects of perioperative BB audio on anxiety, pain, and hemodynamic parameters in surgical patients were included. The primary outcome was anxiety levels (measured by standardized scales). Secondary outcomes included pain, changes in hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate), and incidence of adverse events (nausea, vomiting, dizziness, hearing impairment, etc.).

Out of 318 studies initially identified, 15 studies were included. Compared to blank audio controls, BB significantly reduced perioperative anxiety (14 trials, n = 1047; SMD = - 1.38, 95 % CI: - 1.89 to - 0.87, P < 0.0001, I² = 91.6 %), postoperative pain (5 trials, n = 433; SMD = - 0.61, 95 % CI: - 1.03 to - 0.19, P = 0.0024, I² = 75.8 %), systolic blood pressure (6 trials, n = 436; MD = - 5.57 mmHg, 95 % CI: - 8.71 to - 2.44, P = 0.3041, I² = 17 %), and heart rate (MD = - 3.37 bpm, 95 % CI: - 5.45 to - 1.29, P = 0.3253, I² = 13.9 %), though effects on diastolic blood pressure were not significant (MD = - 2.33 mmHg, 95 % CI: -5.19 to 0.52, P = 0.0334, I² = 58.7 %). When compared to non-binaural beats (non-BB) audio, BB demonstrated superior reductions in anxiety (8 trials, n = 598; SMD = - 1.01, 95 % CI: - 1.99 to - 0.03, P < 0.0001; I² = 95.4 %) and postoperative pain (3 trials, n = 265; SMD = - 0.52, 95 % CI: - 0.77 to - 0.28, P = 0.9235, I² = 0 %).

Perioperative BB audio significantly reduces anxiety, alleviates pain, and stabilizes key hemodynamic parameters (systolic blood pressure, heart rate), outperforming non-BB audio. BB audio represents a promising non-pharmacological intervention, though inter-trial heterogeneity was substantial. Protocol standardization requires further high-quality RCTs.