The effect of music on anxiety in women undergoing cesarean delivery: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of music on anxiety in patients undergoing cesarean delivery (CD). DATA SOURCES: An electronic search of PubMed, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials was performed from inception to November 2020. STUDY ELIGIBILITY CRITERIA: Eligibility criteria included all randomized controlled trials of pregnant women undergoing CD who were randomized to music intervention or control. Studies needed to measure preoperative, intraoperative, or postoperative anxiety via Visual Analogue Scale (VAS), State-Trait Anxiety Inventory (STAI), or Zung Self-Rating Anxiety Scale (SAS) to be included. The primary outcome was intraoperative anxiety during CD. Secondary outcomes included preoperative and postoperative anxiety, postoperative pain, postoperative opioid requirements, blood pressure and heart rate. STUDY APPRAISAL AND SYNTHESIS METHODS: The methodological quality of the included studies was evaluated using Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of mean difference (MD) with 95% confidence intervals (CI). A pre-specified subgroup analysis for patients undergoing scheduled and unscheduled CD was carried out for the main outcomes. RESULTS: Of 1,296 studies screened, 15 met inclusion criteria (N=613 music group vs. N=748 controls). Three trials (N=217 music group vs. N=215 controls) reported intraoperative anxiety specifically. Among studies using a VAS for anxiety assessment, women in the intervention group had lower intraoperative anxiety compared to controls (MD -0.54, 95% CI -0.87 to -0.20; I2=0%; 2 studies). One trial used STAI and one trial used SAS for intraoperative anxiety assessment. In both of these studies, music was associated with lower anxiety compared to controls (STAI: MD -2.80, 95% CI -4.57 to -1.03; SAS: -4.80, 95% CI -7.08 to -2.52). On subgroup analyses, the same relationship persisted when the CD was unscheduled, as well as when the music was selected by the patient or by the study team. The effect of music on preoperative and postoperative anxiety varied depending on which anxiety assessment tool was used. Music was also associated with decreased opioid use (MD -0.87, 95% CI -1.55 to -0.19; I2=0%). CONCLUSIONS: In patients undergoing CD, music is associated with decreased intraoperative anxiety.