Intraoperative Noise Isolation as an Opioid-Sparing Strategy: A Systematic Review and Meta-analysis

To evaluate the efficacy of intraoperative use of passive noise-isolating earmuffs on postoperative pain intensity, opioid consumption, and recovery quality in patients undergoing general anesthesia.

Systematic review and meta-analysis.

A systematic search was conducted across 9 databases, including PubMed, Embase, CINAHL, and the Cochrane Library, up to December 31, 2025. Two reviewers screened the literature, extracted data, and assessed risk of bias using the Cochrane RoB 2.0 tool. Meta-analysis of outcome measures was performed using RevMan 5.4 software.

A total of 3 randomized controlled trials (296 patients) were included. Results showed that intraoperative noise isolation significantly reduced perioperative opioid consumption (MD = -4.73 morphine milligram equivalents [MME], P =.002) and the number of boluses on patient-controlled intravenous analgesia (PCIA) pumps. It also improved recovery quality at 24 hours postoperatively (QoR-15 scores). Subgroup analysis revealed significantly lower resting pain scores in the laparoscopic surgery group. However, no difference was observed in the endoscopic submucosal dissection (ESD) group. This discrepancy may be attributed to the floor effect of low-pain procedures.

Supported by moderate-certainty evidence, intraoperative noise isolation serves as a safe, cost-effective opioid-sparing strategy that enhances early quality of recovery. Crucially, analgesic efficacy is context-dependent: robust benefits are observed in moderate-pain procedures (eg, laparoscopic surgery), whereas utility in low-pain interventions is limited due to a floor effect.