With great interest, we read the article by Ferraz et al. published in 2021 in the Eur J Pain (Ferraz et al., 2021). The authors performed a randomized controlled trial (RCT) and concluded that “Listening to music is effective for relieving acute procedural pain during the first postoperative tibial fracture dressing change. Music should be incorporated into the multimodal analgesia protocols for management of orthopaedic postoperative wound care related pain.” At the outset, we would like to congratulate the authors for writing an informative article with novelty. Nevertheless, we have several suggestions and queries that we would like to communicate with the authors.

The focus of this RCT was short-term postoperative analgesic effect for diaphyseal tibial fractures, and other studies of music therapy for fracture patients have also shown that music therapy does have a positive effect on short-term postoperative pain control (Ortega et al., 2019; Kwon et al., 2006). Overall, there seems to be substantial evidence that music plays a positive role in reducing postoperative pain and anxiety. However, a recent meta-analysis of music therapy for total knee arthroplasty has found that music intervention does not show significant improvement in pain scores (Yu et al., 2020). Thus, do we need more RCT to further test the effectiveness of music therapy? After all, the degree of effectiveness of music therapy varies according to personal experience and music types. The stimulating range of music therapy includes calming music sung softly or played on an instrument, including lullabies, improvised music, popular music, new age music, classical music or home indigenous music. Music therapists support doctors, nurses and other healthcare professionals in providing patients with appropriate auditory stimulation. Despite the growing interest in music therapy in clinical research, the treatment still faces many challenges before it can be established in widespread clinical practice.

There are several flaws in the study design that are worth mentioning. Regarding assessment, it is not clear whether the surgeon or the anaesthesiologists assessed the ‘physician's satisfaction’. Also, it is unknown whether headphone use might cause some communication difficulties. Furthermore, it is not clear how the physiotherapy in Ferraz et al. study was performed (e.g., the number of daily attempts, the level of assistance required to complete each task). It is unclear if the authors standardized the intraoperative analgesic strategy for these patients as this can significantly alter the studied outcomes. The type of anaesthesia used during the operation was not specified. Was it general anaesthesia or epidural anaesthesia? We know that different types of anaesthesia have different effects on postoperative pain and vas score. As pain is a bad experience for patients, postoperative multimode analgesia was widely used, but the authors did not mention whether patients have been adopted self-controlled analgesia after operation. Another drawback was that there were too few outcome measures, and other important outcomes such as anxiety, adverse events, opioid consumption and patient satisfaction were not evaluated.

We wish that more orthopaedic surgeons interested in multimodal postoperative analgesia to enhance recovery following fracture surgery and provide high-quality care for patients based on the best available evidence. Finally, we would welcome some comments by the authors as this would help to further support the findings of this important clinical trial.

我们怀着极大的兴趣阅读了 Ferraz 等人的文章。发表于 2021 年的Eur J Pain（Ferraz 等人，2021 年）。作者进行了一项随机对照试验 (RCT) 并得出结论：“听音乐可有效缓解术后第一次胫骨骨折敷料更换期间的急性操作性疼痛。音乐应纳入多模式镇痛方案中，以管理骨科术后伤口护理相关疼痛。” 首先，我们要祝贺作者写了一篇内容丰富且新颖的文章。尽管如此，我们还是有一些建议和疑问希望与作者交流。

本次随机对照试验的重点是胫骨骨干骨折术后短期镇痛效果，其他音乐疗法对骨折患者的研究也表明，音乐疗法确实对术后短期疼痛控制有积极作用（Ortega et al., 2019 年；Kwon 等人，2006 年）。总体而言，似乎有大量证据表明音乐在减轻术后疼痛和焦虑方面发挥着积极作用。然而，最近一项对全膝关节置换术音乐疗法的荟萃分析发现，音乐干预并未显示出疼痛评分的显着改善（Yu et al., 2020）。因此，我们是否需要更多的随机对照试验来进一步检验音乐疗法的有效性？毕竟，音乐疗法的有效性程度因个人经验和音乐类型而异。音乐疗法的刺激范围包括轻柔地演唱或在乐器上演奏的平静音乐，包括摇篮曲、即兴音乐、流行音乐、新时代音乐、古典音乐或家庭土著音乐。音乐治疗师支持医生、护士和其他医疗保健专业人员为患者提供适当的听觉刺激。尽管在临床研究中对音乐疗法的兴趣与日俱增，但在广泛的临床实践中建立之前，该疗法仍面临许多挑战。

研究设计中有几个缺陷值得一提。关于评估，尚不清楚外科医生或麻醉师是否评估了“医生的满意度”。此外，不知道使用耳机是否会导致一些沟通困难。此外，尚不清楚 Ferraz 等人的物理治疗如何。进行了研究（例如，每天尝试的次数，完成每项任务所需的帮助水平）。目前尚不清楚作者是否对这些患者的术中镇痛策略进行了标准化，因为这会显着改变研究结果。未指定手术期间使用的麻醉类型。是全身麻醉还是硬膜外麻醉？我们知道不同类型的麻醉对术后疼痛和血管评分的影响是不同的。由于疼痛对患者来说是一种不好的体验，术后多模式镇痛被广泛使用，但作者并未提及患者术后是否采用自控镇痛。另一个缺点是结果指标太少，其他重要结果，如焦虑、不良事件、阿片类药物消耗和患者满意度没有得到评估。

我们希望更多的骨科医生对多模式术后镇痛感兴趣，以促进骨折手术后的恢复，并根据现有的最佳证据为患者提供高质量的护理。最后，我们欢迎作者发表一些评论，因为这将有助于进一步支持这一重要临床试验的结果。