Background: As a mind-body therapy, music may have a positive effect on patients with postoperative pain and anxiety. Objective: The aim of this systematic review and meta-analysis was to explore the effects of perioperative music therapy on postoperative pain and anxiety based on existing clinical trials. Methods: The Cochrane Library, PubMed, and Embase were searched from their inception to August 2022, selected the literature according to the inclusion and exclusion criteria, and completed the meta-analysis using RevMan 5.3. Results: A total of 19 eligible randomized controlled trials were enrolled, including 1803 patients. The results of the meta-analysis showed that the scores of pain (standardized mean difference [SMD], - 0.90; 95% confidence interval [CI], - 1.26 to - 0.53; p < 0.00001) and anxiety (SMD, - 0.75; 95% CI, - 1.19 to - 0.31; p = 0.0008) decreased in the music group on postoperative day 1. The blood pressure (mean difference [MD], - 5.29; 95% CI, - 9.53 to - 1.06; p = 0.01) and heart rate ( MD, - 6.13; 95% CI, - 11.69 to - 0.58; p = 0.03) also decreased on the same day. Further, the score of change in pain (SMD, 0.35; 95% CI, 0.01 to 0.68; p = 0.04) and anxiety (SMD, 1.35; 95% CI, 0.01 to 2.69; p = 0.05) increased between preoperative and postoperative days in the music group. However, the scores of hospital satisfaction ( MD, - 0.07; 95% CI, - 1.40 to 1.27; p = 0.92) and incidences of postoperative nausea and vomiting (risk ratio, 0.41; 95% CI, 0.13 to 1.34; p = 0.14) did not decrease in the music group. Conclusion: Perioperative music therapy can significantly reduce postoperative pain and anxiety and avoid fluctuations in blood pressure and heart rate but does not improve patient hospital satisfaction or incidences of postoperative nausea and vomiting.