Objective: To evaluate the effects of music intervention on pain and anxiety in patients undergoing emergency suturing. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched up to September 9, 2025. Randomized controlled trials comparing music intervention with standard care during emergency laceration repair were included. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I-2 statistic, and evidence certainty was evaluated with the GRADE approach. Results: Four RCTs involving 388 patients were included. Music intervention significantly reduced pain compared with standard care (SMD = -0.28, 95% CI - 0.48 to -0.08; I-2 = 0%). Anxiety scores showed a borderline reduction in the music group (SMD = -0.40, 95% CI - 0.80 to 0.00; I-2 = 20%). Sensitivity analyses supported the robustness of the results. The certainty of evidence was rated as low to moderate. Conclusion: Music intervention during emergency suturing significantly reduces pain and may provide modest benefits in alleviating anxiety.