This pilot study aimed to evaluate the effectiveness of music intervention in reducing perioperative anxiety and improving physiological indicators in patients undergoing orthopedic surgery. A randomized controlled trial design was employed. Participants scheduled for elective orthopedic surgery were randomly assigned to either the music intervention group or the control group. The intervention group received 30 minutes of calming instrumental music via headphones before surgery, while the control group received routine care without music. Anxiety levels were measured using the Visual Analogue Anxiety Rating (VIRA), and physiological indicators including blood pressure (BP), heart rate, and respiratory rate were recorded before and after the intervention. The music group showed a significant reduction in anxiety scores compared to the control group (p < .05). Additionally, there were notable improvements in systolic blood pressure and heart rate within the music group post-intervention. No adverse effects were reported. Music intervention is a simple, non-invasive, and effective method to reduce perioperative anxiety and stabilize physiological parameters in orthopedic surgical patients. This intervention may be considered as part of routine preoperative care.