Preoperative five-element music via noise-cancelling headphones as an adjunct to parecoxib-based analgesia for postoperative pain after painless induced abortion: a randomized clinical trial

Preoperative distress and anxiety commonly occur in young adult females undergoing induced abortion surgery, leading to increased postoperative analgesic requirements and a higher incidence of postoperative nausea and vomiting. Five-element music therapy, based on Traditional Chinese Medicine (TCM) principles, is a non-pharmacological intervention reported to have beneficial effects on pain perception and depression symptoms. However, its effectiveness in preventing postoperative pain and complications after induced abortion has not been established. This randomized trial enrolled women aged 18–35 years undergoing elective abortion under non-intubated general anesthesia. Participants were randomly assigned to either the music therapy group or the control group. The music therapy group received a 30-minute pre-surgical session of five-tone audio therapy guided by the principles of TCM, delivered using noise-cancelling headphones. The control group received the same headphone setup without the music intervention (Fig. S1). Both groups received standardized intravenous anesthesia with propofol and nalbuphine. Immediately before this audio/relaxation intervention, all participants in both groups received a fixed intravenous dose of parecoxib sodium 40 mg (diluted in 5 mL 0.9% saline). The primary endpoint was peak movement-evoked pain (0–10 scale) during the first 4 postoperative hours (assessed at T1, T2, and T3). Pain assessments occurred at three distinct timepoints: immediately upon consciousness restoration (T1), 30 min post-procedure (T2), and prior to discharge (within the 4 h post-surgery) (T3). Secondary outcomes included the maximum resting pain score, pre- and post-procedural anxiety levels evaluated by the SAS and STAI instruments, cumulative opioid administration during the initial four postoperative hours, incidence of postoperative complications (particularly nausea and vomiting), participant satisfaction ratings, and the frequency of supplementary analgesic interventions. A total of 108 patients were screened, of whom 101 were randomized to the music therapy or control group. The music group showed significantly lower maximum postoperative pain scores (2.3 ± 1.2 vs. 3.3 ± 1.1; MD 1.0 [0.5–1.4], P < 0.001) and reduced analgesic rescue requirements (2% vs. 26%). STAI (36.3 ± 10.4 vs. 38.7 ± 9.4; MD 2.4 [-1.6–6.3], P = 0.236) and SAS scores (32.1 ± 6.9 vs. 33.7 ± 6.7; MD 1.7 [-1.0–4.4], P = 0.224) trended lower postoperatively but were nonsignificant. No intergroup differences occurred in nausea/vomiting incidence. Satisfaction rates were 94% (music) versus 68% (control). This randomized trial demonstrates that preoperative five-element music therapy delivered via noise-cancelling headphones, combined with parecoxib sodium and propofol, reduced postoperative pain and improved satisfaction in young women undergoing abortion under non-intubated general anesthesia. Chinese Clinical Trial Registry (ChiCTR), registration number ChiCTR2400080886 registered on 16 February 2024.