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A Prospective Randomized Study of the Effectiveness of Aromatherapy for Relief of Postoperative Nausea and Vomiting


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Postoperative nausea and vomiting (PONV) is a major concern for patients having surgery under general anesthesia as it causes subjective distress along with increased complications and delays in discharge from the hospital. Aromatherapy represents a complementary and alternative therapy for the management of PONV. The objective of this study was to compare the effectiveness of aromatherapy (QueaseEase, Soothing Scents, Inc, Enterprise, AL) versus an unscented inhalant in relieving PONV. One hundred twenty-one patients with postoperative nausea were randomized into a treatment group receiving an aromatic inhaler and a control group receiving a placebo inhaler to evaluate the effectiveness of aromatherapy. Initial and follow-up nausea assessment scores in both treatment and placebo groups decreased significantly (P < .01), and there was a significant difference between the two groups (P = .03). Perceived effectiveness of aromatherapy was significantly higher in the treatment group (P < .001). Aromatherapy was favorably received by most patients and represents an effective treatment option for postoperative nausea.
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A Prospective Randomized Study of the
Effectiveness of Aromatherapy for Relief
of Postoperative Nausea and Vomiting
Nancy S. Hodge, RN, MSN, BSN, ACNS-BC, Mary S. McCarthy, RN, PhD, MN, BSN,
Roslyn M. Pierce, BA
Introduction: Postoperative nausea and vomiting (PONV) is a major con-
cern for patients having surgery under general anesthesia as it causes
subjective distress along with increased complications and delays in dis-
charge from the hospital. Aromatherapy represents a complementary and
alternative therapy for the management of PONV.
Purpose: The objective of this study was to compare the effectiveness ofaro-
matherapy (QueaseEase, Soothing Scents, Inc, Enterprise, AL) versus an
unscented inhalant in relieving PONV.
Methods: One hundred twenty-one patients with postoperative nausea
were randomized into a treatment group receiving an aromatic inhaler
and a control group receiving a placebo inhaler to evaluate the effective-
ness of aromatherapy.
Findings: Initial and follow-up nausea assessment scores in both treatment
and placebo groups decreased significantly (P,.01), and there was a signif-
icant difference between the two groups (P5.03). Perceived effectiveness of
aromatherapy was significantly higher in the treatment group (P,.001).
Conclusions: Aromatherapy was favorably received by most patients and
represents an effective treatment option for postoperative nausea.
Keywords: aromatherapy, postoperative nausea, complementary ther-
apy, CAM, research, perianesthesia nursing.
Published by Elsevier Inc. on behalf of the American Society of
PeriAnesthesia Nurses
(PONV) is a major concern of providers for pa-
tients having surgery under general anesthesia.
PONV is associated with subjective distress as
well as increased complications and delays in dis-
charge from the hospital. The consequences of
prolonged nausea and vomiting significantly affect
postoperative morbidity and include dehydration,
electrolyte disturbances, aspiration, and even
wound dehiscence.
Aromatherapy represents
a complementary and alternative therapy to the
management of PONV.
Nancy S. Hodge, RN, MSN, BSN, ACNS-BC, is a Medical-Surgi-
cal Clinical Nurse Specialist, Center for Nursing Science &
Clinical Inquiry, Madigan Army Medical Center, Tacoma,
WA; Mary S. McCarthy, RN, PhD, MN, BSN, is a Senior Nurse Sci-
entist, Center for Nursing Science & Clinical Inquiry, Madigan
Army Medical Center, Tacoma, WA; and Roslyn M. Pierce, BA,
is a Research Assistant, Center for Nursing Science & Clinical
Inquiry, Madigan Army Medical Center, Tacoma, WA.
The views expressed in this article are those of the authors
and do not reflect the official policy of the Department of the
Army, the Department of Defense, or the US Government. The
investigators have adhered to the policies for protection of hu-
man subjects as prescribed in 45 CFR 46.
Conflict of interest: QueaseEase and placebos were pro-
vided free of charge.
Address correspondence to Nancy S. Hodge, 6908 65th Ave-
nue West, Lakewood, WA 98499; e-mail address: nancy.s.
Published by Elsevier Inc. on behalf of the American Society
of PeriAnesthesia Nurses
Journal of PeriAnesthesia Nursing, Vol 29, No 1 (Februar y), 2014: pp 5-11 5
Literature Review
Depending on the number of risk factors a patient
has for PONV, the incidence ranges anywhere from
10% to 87%. This is not surprising, given that dif-
ferent surgical populations, procedures, and anes-
thetic methods influence PONV.
Most patients
and surgeons believe PONV is caused by the
anesthetic agent used for the procedure.
ever, there is literature to support a significant re-
duction in PONV with the introduction of
halogenated inhalational agents in the 1960s.
The problem of PONV continues to persist unfor-
tunately; the mechanisms for it are numerous and
the causative pathways are not well elucidated.
In 1997, Koivuranta et al described PONV risk fac-
tors in the adult surgical population. These risk fac-
tors included female gender, non-smoking status,
history of PONV, history of motion sickness, and
duration of surgery greater than 60 minutes.
1999, Apfel et al identified female gender, non-
smoking status, history of PONV or motion sick-
ness, and postoperative opioids as the four most
significant predictors of PONV. The propensity
for the development of PONV is cumulative with
each additional risk factor adding to the risk of oc-
currence. For example, with one risk factor the
PONV risk is 10%, but if four risk factors are re-
ported, the PONV risk rises to 80%.
Current drug therapies used to treat PONV such as
dopamine receptor antagonists (eg, metoclopra-
mide) and butyrophenones (eg, droperidol) have
occasional undesirable side effects that include ex-
cessive sedation, hypotension, dry mouth, extrapy-
ramidal reactions, and limited dosing abilities.
Some drug combinations may have additional ad-
verse effects such as headache, dizziness, and
drowsiness. The negative outcomes of PONV may
require additional medications, more attention
from nurses and physicians, and an extended hos-
pital length of stay, all of which increase the cost
of related health care.
Alternative treatments are now being used to help
control PONV with early favorable results. These
treatments include nausea relief bands (pressure
point or electrical stimulation), intraoperative
high concentration oxygen administration, acu-
pressure, acupuncture, music, and aromatherapy.
Aromatherapy, a complementary therapy, is de-
fined as ‘‘treatment using scents.
It is a relatively
new area of research for PONV. These non-
pharmacologic modalities are appealing to many
patients and assist in the emotional and physical
healing that enhances one’s overall well-being
and quality of life.
Smiler and Srock found that
aromatherapy with isopropyl alcohol effectively
treated the nausea caused by the motion patients
experience while being transported on a gurney.
Wang et al found that isopropyl alcohol was more
effective than placebo as the initial treatment for
nausea in children, although the effect was limited
to less than 1 hour.
Merritt et al were unable to
demonstrate a beneficial effect of isopropyl alco-
hol inhalation in patients with PONV; their study
had no control group and a small sample size.
A randomized, double blind study by Anderson
and Gross enrolled subjects experiencing PONV
to receive aromatherapy with isopropyl alcohol,
oil of peppermint, or placebo (saline).
The va-
pors were inhaled from scented gauze pads held
directly beneath the nose. Subjects were instructed
to exhale slowly through their mouth. They rated
their nausea on a visual analog scale at 2 and 5 min-
utes after the inhalation. Overall nausea scores
decreased from 60.6 64.3 mm before aromather-
apy to 43.1 64.9 mm (P,.005) at 2 minutes
and to 28.0 64.6 mm (P,.0001) at 5 minutes after
aromatherapy. While decreased, nausea scores did
not differ between groups. Only 52% of the sub-
jects required additional antiemetic therapy during
their post-anesthesia care unit (PACU) stay. Overall
patient satisfaction with postoperative nausea
management was 86.9 64.1 mm and was indepen-
dent of treatment group. The researchers con-
cluded that aromatherapy effectively reduced
perceived severity of PONV and that the ben eficial
effect may be related to the controlled breathing
patterns that subjects were instructed on during
the study. This study did provide support for iso-
propyl alcohol as well as herbal inhalations. No
safety concerns for subjects were identified.
Aromatherapy formulations that have been popu-
lar alone or as adjuncts to conventional treatments
include peppermint oil ingestion for morning sick-
ness, dyspepsia, and other gastrointestinal com-
plaints; peppermint oil vapor for the reduction of
postoperative nausea in surgical gynecology pa-
tients; and ginger as a powder, candy, or oil to
reduce the incidence of 24-hour PONV among
patients undergoing gynecologic and lower ex-
tremity surgeries.
Only one study was found
that described the use of lavender oil aromather-
apy for postoperative pain; the treatment group
pain scores were not significantly different than
the control group, but overall satisfaction with
pain control was higher in the group receiving lav-
ender aromatherapy.
There is a paucity of research using aromatherapy
interventions for PONV, with few new studies in
the last decade. A recent review published in The
Cochrane Library examined six randomized con-
trolled trials and three clinical controlled trials to
establish the effectiveness of aromatherapy on the
severity and duration of PONV in a total of 402
participants. The conclusion of the reviewers was
that isopropyl alcohol was more effective than sa-
line placebo for reducing PONV but less effective
than standard anti-emetic drugs. Patient satisfaction
was not different between groups receiving aroma-
therapy or standard therapy.
The purpose of this study was to compare the
effectiveness of aromatherapy delivered by a hand-
held inhaler (QueaseEase; Soothing Scents, Inc, En-
terprise, AL) to an unscented inhaler for reducing
PONV in patients who were admitted to a surgical
unit for at least 24 hours postoperatively.
A prospective randomized two-group design was
used with the treatment group receiving an aromatic
inhaler and the control group receiving a placebo
This study was conducted in a 250-bed military
medical center in the Pacific Northwest. Human
subjects approval was granted by the hospital’s In-
stitutional Review Board before initiating the
study. Study inclusion criteria were adult surgical
patients with planned admission to the inpatient
unit for postoperative care. Patients with an allergy
to lavender, peppermint, spearmint, or ginger
were excluded. Patients were recruited from
the Pre-Admission Surgery Center and enrolled 1
to 5 days before surgery with documentation of in-
formed consent. Study procedures were initiated
with the first complaint of nausea on the postoper-
ative inpatient unit. Because of the reported asso-
ciation between tobacco use and decreased
PONV, we decided to ask patients about nicotine
use and compare rates of PONV between users
and non-users.
A self-administered scented QueaseEase inhaler
or an unscented identical inhaler was used as an
immediate treatment for nausea and was followed
by prescribed antiemetic therapy if ineffective.
QueaseEase is an over-the-counter aromatherapy
product formulated as an aromatic inhaler con-
taining a proprietary blend of lavender, pepper-
developed by a nurse who intended it to be
used for morning sickness, motion sickness, and
nausea related to chemotherapy, and postopera-
tive recovery.
The inhaler is a portable, handheld
device that can be kept at the patient’s bedside for
immediate use. The patient is instructed to remove
the cap, hold the container under the nose, and take
a few deep breaths. The patient can use it as often as
needed and the product is effective for up to
6 months if the cap is replaced tightly after each
use. There are no known or reported risks to this
therapy except allergy to any of the oils used in
the inhaler.
Patients completed two 10-point Likert-type
scales (0 5none, 10 5worst possible) rating
nausea at baseline and after 3 minutes, as well
as questionnaires addressing satisfaction with
nausea treatment and perceived effectiveness of
aromatherapy. In addition, 10% of patients were
asked to participate in an individual brief inter-
view with one of the research team members to
discuss attitudes about aromatherapy. The study
included the period of time from the first postop-
erative episode of nausea until 24 hours later,
with the brief interview planned for 10% of pa-
tients at 24 hours or upon discharge, whichever
came first. Using previous studies involving aro-
matherapy, the following considerations were in-
cluded in the power analysis: allowing for an
attrition rate of 10%, alpha 50.05 and a standard
deviation on questionnaire responses of 0.5 to 1,
and a beginning sample size of 60 subjects in
each group was required to determine if a statisti-
cally significant difference between groups ex-
Patients evaluated and ranked their nausea on a de-
scriptive ordinal scale with 0 5‘‘no nausea’’ and
10 5‘the worst nausea ever.’’ Unpaired ttests
were used to compare scores at baseline and at
the 3-minute post-aromatherapy interval between
groups while paired ttests were used for within
group comparisons at the two time points. Inde-
pendent ttests were used to compare scores on
the patient satisfaction question with 0 5‘com-
pletely dissatisfied’’ and 10 5‘‘completely
satisfied’’ and the perceived effectiveness of aro-
matherapy question with 0 5‘‘completely ineffec-
tive’’ and 10 5‘completely effective.’’ Statistical
analyses were performed using SPSS, v14.0 (IBM,
Armonk, NY) with significance set at P,.05.
Of 339 enrolled patients, 121 patients experi-
enced PONV. Ninety-four patients received an in-
haler device; 54 received the treatment inhaler
and 40 received the placebo inhaler. Twenty-
seven patients were not offered the inhaler for var-
ious reasons such as the nurse did not realize the
patient was enrolled in the study before giving
the intravenous antiemetic, had not received train-
ing for carrying out the protocol, or felt he/she was
too busy to administer the protocol. One patient
chose not to use the inhaler when nauseated and
another vomited before the inhaler could be ad-
ministered. Demographic data including gender,
age, and tobacco use are illustrated in Table 1.A
change score was computed for the initial and
follow-up nausea assessment scores. Nausea scores
in both the treatment group and the placebo group
decreased significantly, P,.01 respectively, and
there was a significant difference between the
two groups, P5.03 (Figure 1). Perceived effective-
ness of aromatherapy was examined between
groups. The scores for patients in the treatment
group (M 55.72 63.26) were higher than in the
placebo group (M 52.72 63.12). This 3-point dif-
ference between means was statistically significant
(95% confidence interval 51.60 to 4.39 points;
two-tailed Student ttest, t54.27; df 584;
P,.001). Independent sample ttests showed no
difference between groups on their ratings of over-
all satisfaction with nausea management; both
groups rated satisfaction between 6.8 and 7.1 on
the 0-10 Likert scale (Figure 2).
Table 1. Demographic Data
Number of Subjects
N (Total Enrolled) 5339 Percent (%) of Subjects
PONV event 121 35.7
Gender—female 220 66.5
Age $40 y 161 47.4
Tobacco use 57 17.2
Operative procedure
Cervical/lumbar discectomy/laminectomy 24 8.1
Incision and drainage 3 1.0
Laparoscopic/resectional gastric bypass/sleeve*50 17.0
Laparotomy 18 6.1
Mammoplasty*32 10.9
Neck dissection 4 1.4
Open reduction internal fixation 12 4.1
Osteotomy 9 3.0
Panninculectomy 18 6.1
Arthroplasty (knee, shoulder, other joint) 26 8.8
Thyroidectomy 8 2.7
TAH/TVH*32 10.9
Uro-gynecologic procedures 21 7.2
Other 82 24
PONV, postoperative nausea and vomiting; TAH, total abdominal hysterectomy; TVH, total vaginal hysterectomy.
*Denotes top 3 diagnoses for patients experiencing PONV.
Ten percent of the patients were randomly se-
lected to volunteer additional information in a brief
interview concerning their aromatherapy experi-
ence. Comments suggested that the aromatherapy
was more effective for lower levels of nausea. Sev-
eral patients who received the placebo inhaler
asked if they could have a ‘‘real’ inhaler for their
discharge home at the end of the study period.
One patient felt the aromatherapy was more effec-
tive than the acupressure bracelets she had used
while in PACU. And one patient who had brought
his own essential oils with him to the hospital to
use in the event of PONV said he was pleased be-
cause he did not even need to use his own oils.
While generally pleasing to patients, one patient
did say the fragrance made the nausea worse.
Evidence-based nursing interventions are desper-
ately needed for surgical patients experiencing
PONV. When looking to the literature to uncover
evidence for a nursing policy for postoperative
care, the research team noted the lack of current
and relevant therapies for short-stay surgical pa-
tients. This led to the current research study,
which resonated with all staff nurses in the
medical-surgical unit. Having bedside nurses as
partners, actively engaged in the project, led to
a greater appreciation for evidence-based practice
as well as teamwork to best meet the needs of the
postoperative patient.
This study demonstrated that surgical patients in
this hospital are in favor of using aromatherapy
as a first-line approach to PONV. Patients fre-
quently commented that the lack of effectiveness
and negative side effects of antiemetics were major
concerns for them, especially those who re-
counted past experiences with PONV. Patients
who were tobacco users did indeed have a lower
rate of PONV, which is congruent with the current
literature. The lower rate in smokers has been at-
tributed to smoking-induced changes in the senses
of taste and smell, but the decreased incidence of
PONV among smokers actually results from the
chemicals in cigarette smoke affecting liver
enzyme production, which, in turn, increases me-
tabolism of several anesthesia drugs.
Further ex-
ploration is warranted as nicotine patches have
been unable to produce the same results.
overall success of the aromatherapy and the posi-
tive experience for staff nurses led to rapid ap-
proval of the QueaseEase product as a standard
item in our Omnicell supply system on all inpatient
units. The adoption of this product is widely
known in the institution; other inpatient and out-
patient areas frequently ask how to order the
item. The study results, and the proper indications
for use of the product, are mentioned at every new
employee nursing orientation class.
The study results are limited to the experience in
a single institution with the only product of its
Figure 1. Mean difference initial and follow-up
nausea scores.
Figure 2. Mean difference satisfaction overall and
perceived effectiveness.
kind on the market at the time. The research team
was comprised strictly of volunteers and subject
accrual was somewhat dependent on the availabil-
ity of the team on any given day. However, there
were no attempts to seek out a specific population
and the results demonstrate that patients under-
went a wide range of surgical procedures. There
were more female volunteers, but this is a reflec-
tion of the high number of gynecologic proce-
dures performed on most days in this facility. The
intervention related to the study involved only
a 3-minute interval of time; the first experience
of nausea described by the patient evaluated on
notification of the nurse and 3 minutes following
the use of the inhaler brought to the bedside.
Many factors could impact this experience and
the response to the inhaler, to include pain, an al-
tered level of consciousness, or other lingering
aromas from anesthetic agents, blood, and so on.
Although patients had orders for intravenous or
oral antiemetic medication, there was no attempt
to collect information regarding use and effective-
ness of rescue medications when aromatherapy
was ineffective.
Lastly, the sample size fell short of the recommen-
ded number for enrollment according to the a pri-
ori power analysis, but statistical significance was
achieved nonetheless.
Further Research
The current interest in complementary and alter-
native therapies presents numerous opportunities
for nurses to conduct further research into uses of
aromatherapy. Additional research is needed to
evaluate aromatherapy for the nausea associated
with chemotherapy and morning sickness. Com-
parisons between modalities for nausea such as
aromatherapy and antiemetic bands, or guided
imagery, or music, would make interesting evi-
dence-based practice research activities. Such in-
formation may strengthen the evidence for
aromatherapy or identify adjunct modalities to en-
hance patient comfort.
In conclusion, the use of aromatherapy and a dedi-
cated team of nurses led to a high rate of satisfac-
tion with overall management of PONV on the
medical-surgical units. Aromatherapy was favor-
ably received by most patients and represents an
effective treatment option for postoperative nau-
sea. The nurse is not always able to respond as
promptly as desired to obtain and administer an
IV antiemetic. A device such as an aromatherapy
inhaler is immediately available to the patient
and if it does not completely relieve the nausea,
it may help the patient in the short period of
time waiting for the IV antiemetic to be adminis-
tered. This evidence-based nursing therapy is
now available to the bedside nurse in our institu-
tion to offer to patients with postoperative nausea.
Continued use and additional data will help to de-
termine if this intervention is deserving of a best
practice recommendation for bedside nurses car-
ing for postoperative patients.
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... Post-operative Nausea and Vomiting (PONV) are the most common symptoms that occur within the first 24 hours of surgery. 1 In relation to surgical, anaesthesiologic, and patient-specific risk factors, the global incidence of PONV ranges from 30% to 80%. 2,3 The type and length of surgery, the anaesthetic technique used (regional anaesthesia or general anaesthesia), and the use of volatile anaesthetics (nitrous oxide, N2O, or opioid analgesics) are all risk factors for surgical and anaesthetic procedures. 4 Female sex, young age, anxiety, a prior history of PONV, a history of motion sickness, and non-smoker status are all patient-related risk factors. ...
... 4 Female sex, young age, anxiety, a prior history of PONV, a history of motion sickness, and non-smoker status are all patient-related risk factors. 2,5 Several risk stratification tools for PONV have been proposed with the aim of targeting specific preventive strategies; depending on the level of risk detected, prophylaxis is administered, either with a specific drug or a combination therapy of antiemetic drugs with distinct action mechanisms. 6 Post-operative Nausea (PON) causes anxiety and discomfort in the patient, whereas Post-operative Vomiting (POV) can result in more serious complications such as dehydration, electrolyte imbalances, airway compromise, surgical wound dehiscence, oesophageal lacerations, and hypotension, 1,7 resulting in more days of hospitalisation and associated healthcare costs. ...
... 10 Aromatherapy, 11 which involves the therapeutic use of the aroma of essential oils of a plant nature, is the most widely used CAM. 12 Although there are few studies on the use of aromatherapy in reducing PONV, the current evidence suggests that aromatherapy has a positive effect in reducing post-operative nausea and vomiting and could thus be considered as a complementary therapy to antiemetic drugs. 1 One study demonstrated the benefit of aromatherapy using peppermint, ginger, or a combination of lavender, peppermint, ginger, and spearmint oils in reducing post-operative nausea. 2 Some studies also report high patient satisfaction with aromatherapy treatment, citing an improvement in comfort. 2,13 Lavender essential oil is 100 times more effective than the plant itself, and it has been used medicinally as a sedative, narcotic, antiinflammatory, antidepressant 14 and antiemetic. 15 Although there is evidence that aromatherapy has positive effects, there have been no studies published to date that have used aromatherapy with the sole use of lavender to treat post-operative nausea and vomiting. ...
Full-text available
Background: The most common post-operative symptoms are nausea and vomiting. Aromatherapy has been shown to reduce post-operative nausea and vomiting and thus could be used as a complementary therapy to antiemetic drugs; however, no studies have considered the exclusive use of Lavender in these patients. The study’s aim is to assess aromatherapy in reducing nausea and vomiting in post-operative patients. Materials and Methods: A 2-arm randomised controlled interventional study was carried out in the Neurosurgery, General Surgery, Vascular Surgery, and Gynaecology facilities of the SS Antonio e Biagio e Cesare Arrigo Hospital of Alessandria. Study inclusion criteria: patients over the age of 18, who sign an informed consent form, have had an anaesthesiologic examination, have had general anaesthesia, and are clinically stable with a nausea score of NRS>0. Multiple instruments will be used, including a numerical rating scale, a Likert rating scale, and a Likert rating scale to assess Vomiting and the degree of satisfaction. Conclusions: The use of complementary non-pharmacological methods such as aromatherapy may help patients feel more comfortable in the post-operative period.
... 2 Nausea and vomiting may also lead to complications during the recovery period, such as dehydration, postoperative bleeding, wound complications and electrolyte imbalance. 3 Given the common occurrence and negative impacts of PONV, aromatherapy has become a complementary therapy of interest for decreasing PONV. 4 Since aromatherapy has become more integrated into adult care and in some pediatric areas, we were interested in exploring the possibility of using aromatherapy with pediatric outpatient surgical patients. ...
... [6][7][8] However, commonly reported findings included enhanced patient satisfaction and no adverse effects. 3,6,8,9 Clinical guidelines published by the Society for Ambulatory Anesthesia at the time of this current research project supported the use of aromatherapy as a rescue measure for the management of PONV for adults and children. 2,10 An updated Cochrane Review was published in 2018 with the purpose of reporting the relationship of aromatherapy with the severity and duration of PONV. 9 Sixteen randomized controlled trials were reviewed; two of the 16 involved a pediatric population. ...
... Quea-seEASE was selected because of the aroma blend documented in the literature review to reduce PONV for adults and children. 3,12 The pod consists of a foil pack, where the foil is peeled back and the scent inhaled. Another advantage of QueaseEASE is that with proper storage, it can be used multiple times and for 24 to 48 hours from the time it is opened. ...
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Purpose To explore whether an aromatherapy product, QueaseEASE, could be used to supplement standard postoperative nursing care for children experiencing discomfort from postoperative nausea and vomiting (PONV) in a pediatric outpatient surgical setting. Design Evidence-based practice project resulting in a prospective, descriptive research design. Methods English-speaking pediatric outpatient surgical patients 8 to 17 years of age were evaluated for symptoms of discomfort during the postoperative phase of care, using the Baxter Animated Retching Faces (BARF) scale and offered the QueaseEASE aromatherapy product. A postoperative phone call was made the next business day to inquire about use of product at home. Findings Thirty-one patients rated their BARF scores as four or greater and were qualified to use the aromatherapy pod. Twenty-four patients (77.4%) demonstrated a positive response to the aromatherapy, as evidenced by a BARF score improvement of 2 or more points upon reassessment. Fourteen of the 27 patients (51.8%) contacted at home during the postoperative phone call stated continued use of the aromatherapy pod, and 100% of the families were satisfied with this adjunct therapy. Conclusions Aromatherapy resulted in an improvement in self-reported nausea scores in a pediatric surgical outpatient population and was a family satisfier. Further research is recommended.
... 9 Yine farklı hasta grupları ile yapılan bazı güncel araştırmalarda da aromaterapinin postoperatif bulantı-kusmanın azaltılmasında etkili olduğu bildirilmektedir. 15,23,39 Bu sonuçlara göre sezaryen sonrası bulantı-kusmanın yönetimine aromaterapinin etkinliğini değerlendiren yüksek kaliteli randomize kontrollü çalışmalara gereksinin olduğu düşünülmektedir. ...
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Amaç: Bu çalışmanın amacı sezaryen sonrası gelişen ağrı, bulantı-kusma, abdominal şişkinlik ve anksiyetenin yönetiminde aromaterapi uygulamasının etkinliğini incelemektir.Yöntem: Bu sistematik derleme ve meta-analiz için taramalar Mart-Nisan 2021 tarihleri arasında “aromaterapi (aromatheraphy) AND sezaryen (cesarean section)” anahtar kelimeleri ile PubMed, EBSCO, Embase, Web of Science, PsycINFO, Cochrane, Türkiye Klinikleri, TR Dizin ve Ulusal Tez Merkezi veri tabanlarında yapılmıştır. Araştırmaların metodolojik kalitesi Joanna Briggs Institute tarafından geliştirilen deneysel ve yarı deneysel çalışmalar için Kritik Değerlendirme Kontrol Listeleri ile değerlendirilmiştir. Veriler meta-analiz yapılarak sentez edilmiştir. Bulgular: Çalışmaya 2011–2021 yıllarında yayımlanan 14’i randomize plesebo kontrollü deneysel ve biri yarı deneysel olmak üzere toplam 15 araştırma dâhil edilmiştir. Araştırmaların toplam örneklem hacmi 1430’dur (aromaterapi: 762 ve plasebo: 668). Sekiz çalışmanın birleştirilmiş sonuçları aromaterapi grubunda ağrı yoğunluğunun kontrol grubuna göre istatistiksel olarak anlamlı bir şekilde daha düşük olduğunu göstermiştir (MD: -1.61, Z= 5.15, p< 0.0001). Üç araştırmanın birleştirilmiş sonuçlarına göre aromaterapi grubunun anksiyete puan ortalamasının (MD: -9.68, Z= 3.52, p= 0.0004) ve dört araştırmada da bulantı-kusma görülme olasılığının (OR: 0.29, Z= 3.17, p= 0.002) kontrol grubuna göre daha az olduğunu gösterilmiştir. Yine iki araştırmanın sonuçları da aromaterapi grubunun orta ve şiddetli düzeylerde abdominal şişkinlik görülme olasılığı bakımından kontrol grubuna benzer iken (OR: 0.39, Z= 1.04, p= 0.30), şişkinliğe bağlı ağrının aromaterapi grubunda daha az olduğu (OR: 0.16, Z= 3.18, p= 0.001) saptanmıştır.Sonuç: Bu çalışma bazı bitkiler ile yapılan aromaterapilerin sezaryen sonrası gelişen postoperatif ağrı, anksiyete, bulantı-kusma ve abdominal şişkinliğe bağlı ağrıyı azaltmada etkili olduğunu göstermiştir.
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Farklı Yaklaşımlarla BÜTÜNCÜL VE FONKSİYONEL TIP Bu Kitap; Bütüncül ve Fonksiyonel tıbba dair güvenilir bir genel bakış, yaygın rahatsızlıkları tedavi ederken Fonksiyonel Anatomi Eğitiminin önemi ve genel sağlığı geliştirmek için Bütüncül ve Fonksiyonel Tıpla nelerin birleştirilebileceğini incelemek için akupunkturdan yogaya kadar popüler terapileri, ilaçları, uygulamaları ve prosedürleri sergiliyor. İnsan oğlu zaman tünelinde doğru hareket etmeyi unutuyor. Sürekli olarak kas dengesizlikleri, sürekli ağrı ve düşük enerji ile yaşıyor. Bu yaşantısının sonucunda hastalıklar ile karşılaşması kaçınılmaz oluyor. Bu olumsuzluklar ile karşılaşmamak için ilk tıp bilimi olan anatomi anahtar konumundadır. Doğru zamanda doğru anatomi eğitimi almak ve kalıcı anatomiyi öğrenmek bütün karşılaşılacak olası hastalıklar hakkında % 85’e yakın bir oranda yorum yapabilme kabiliyeti kazandırır. Çünkü insan bedenine yapılacak her tıbbi girişim anatomi ile başlar. Fonksiyonel Anatomi Eğitimi bilgilerin ışığında bedene uygulanacak rehabilitasyon bir egzersizdir. Bileşik ve çok yönlü hareketler kullanarak normal, sağlıklı güç ve hareketliliği geri kazanmayı amaçlar. Fonksiyonel Anatomi Eğitimi, kasların işlevi ile birlikte bedenin nasıl iyi olabileceğini ortaya koyar. Fonksiyonel Anatomi Eğitimi denetiminde yapılan antrenmanlar sadece fiziksel performansı değil, aynı zamanda zihinsel durumu da iyileştirmektedir. Daha iyi hareket etmek, daha net düşünmek, enerjik hissetmek ve hatta daha verimli yaşamak için Fonksiyonel Anatomik eğitimin rehberliğinde antrenman yapmalıyız. Fonksiyonel Anatomi Eğitimi ve ötesi, aynı zamanda beynimizde tıpkı vücudumuz gibi nasıl eğitebileceğimizi ve bunu kapsamlı, çok yönlü bir programa nasıl dahil edebileceğimizi sağlayacak olan ilk tıp bilimidir. Sunmuş olduğumuz bu eser; alanında yetkin ve tecrübelere sahip bilgileri ile zenginleştiren akademisyenlere ait çalışmalar Bütüncül ve Fonksiyonel Tıbbın geleceğine projektör olacaktır. Saygılarımızı Sunarız. Prof. Dr. Yusuf Kenan HASPOLAT Prof. Dr. Vatan KAVAK
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Osteopatik manipülatif tedaviler (OMT), sistemik homeostazı ve toplam hasta sağlığını düzeltmek için farklı vücut yapılarının uygulamalı manipülasyonlarını içerir. Hasta temelli yaklaşımın bu alanı, zihin-beden-ruh temelli tedavinin osteopatik ilkeleri birçok sağlık çalışanının ilgisini çekmektedir (1). OMT, bir hastanın somatik disfonksiyonla ilişkili problemini tedavi etmek için kullanılır. Somatik sistemin ilgili bileşenlerinin (iskelet, artrodiyal ve miyofasyal yapılar ve ilgili vasküler, lenfatik ve nöral elemanlar) bozulmuş veya değişmiş işlevini düzeltmek temel prensipler arasındadır. Somatik disfonksiyon tanısı, TART tarafından tanımlanan dört tanı kriterinden (doku yapısı anormalliği, asimetri, hareket kısıtlaması ve hassasiyet) en az birini tanımlayan yapısal incelemeden elde edilir. Somatik disfonksiyon, bir vücut bölümünün pozisyonu, serbest hareket yönü veya kısıtlı hareket yönü olarak tanımlanabilir. Yapısal inceleme, somatik işlev bozukluğu olan bir bölgeyi belirlemek için vücudun taranmasını, bölge içindeki yerini belirlemek için taramayı ve somatik işlev bozukluğunu kesin olarak tanımlamak için yerel tanıyı içerir (2).
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Kupa tedavisi, lokalize negatif basınçla cildi vakumlayan bir veya daha fazla cam, plastik veya bambu bardağın kullanıldığı bir tekniktir (1). Kupa tedavisi çeşitli hastalıkları tedavi etmek için kullanılmıştır. Dört bin yıldan uzun süredir herpes zoster, hipertansiyon, felç, öksürük, astım ve bel ve boyun ağrısı gibi iskelet sistemi rahatsızlıklarında kullanılmıştır. Günümüzde, profesyonel sporcularında kupa tedavisini kullanmaya olan ilgileri artmıştır (2). Ünlü basketbolculardan Lebron James, Russel Westbrook ve James Harden, olimpik birçok altın madalya almış Amerikalı yüzücü Michael Phelps bu sporculara örnektir. Benzer olarak sporun birçok alanında kupa tedavisinin uygulandığı, sportif başarıları arttırdığı ve ağrıları azalttığı görülmektedir. Tam olarak etki mekanizması bilinmese de dokudaki kan transportunu arttırdığı ve bu sayede oksijenasyonu geliştirdiği bilinmektedir. Kupa tedavisi, cildin kan akışını hızlandırabileceği, cildin biyomekanik özelliklerini değiştirebileceği, ağrı eşiklerini artırabileceği, lokal anaerobik metabolizmayı iyileştirebileceği, iltihabı azaltabileceği ve bağışıklık sisteminin hücresel mekanizmalarını modüle edebileceği için hem masaj uygulamalarına hem de kriyoterapiye göre daha üstün bir role sahip olabilir (3). Kupanın terapötik etkisini gösterdiği spesifik mekanizma tam anlamıyla bilinmemektedir. Bununla birlikte, bir dizi teori öne sürülmüştür. Taibah adı verilen bir yöntem, ıslak kupa uygulamasının yapay bir böbreği taklit ettiğini öne sürüyor (3, 4). Bir in vivo çalışmada böbrek hidrofobik materyalleri glomerüllerden normal basınçlı filtrasyon yoluyla filtrelerken, ıslak kupalama hem hidrofilik hem de hidrofobik materyali yüksek basınçlı filtrasyon yoluyla filtreler. Emmeden kaynaklanan yüksek basınç kan hacminin artmasına, kılcal filtrasyon hızının artmasına ve bölgede filtrelenmiş interstisyel sıvının dışarı çıkmasına neden olur (4).
Postoperative nausea and vomiting is an increasingly common and distressing problem faced by patients undergoing anesthesia that negatively affects their recovery and wellbeing and can result in significant increases in healthcare costs. Effective treatment strategies and relevant, up-to-date guidance are essential to manage postoperative nausea and vomiting in the perioperative setting. This practical, concise guide to the subject offers information on the history and mechanisms of postoperative nausea and vomiting, assessing and identifying risk factors, providing appropriate pharmacological and non-pharmacological treatment options, and implementing successful management strategies to tackle this issue. As a uniquely comprehensive study of the topic that provides much more detail than a chapter in a general anaesthesia textbook, this is an invaluable resource for anesthetists and physicians managing patients post-surgery.
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RECURRENCE RATES AFTER MODIFIED LIMBERG FLAP PROCEDURE FOR THE TREATMENT OF PILONIDAL DISEASE VARY BETWEEN 0%-10%: WHY IS THERE SUCH A BIG DIFFERENCE WITHIN RECURRENCE RATES? Mehmet Eren Yüksel, Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey e-mail: Abstract: Introduction: Modified Limberg flap technique is applied for the treatment of pilonidal disease. Aim: We aimed to determine recurrence rates after modified Limberg flap procedure. Method: A Pubmed search between 2009-2021 was performed in order to identify studies reporting complications and recurrence rates after modified Limberg flap procedure for the treatment of pilonidal disease. Nineteen studies were identified. Results: Recurrence rates after modified Limberg flap procedure were 5.4% (Can et al., 2010), 0.97% (Akin et al., 2010), 10% (Aren et al., 2010), 1.67% (Elshazly et al., 2011), 4.2% (Kaya et al., 2012), 0% (Karaca et al., 2012), 2.8% (Ahmed et al., 2013), 3% (Bessa et al., 2013), 3.3% (Shabbir et al., 2014), 0% (Yildiz et al., 2014), 6.8% (Bayhan et al., 2015), 6.5% (Tokac et al., 2015), 0.8% (Yoldas et al., 2015), 2% (Saydam et al., 2015), 4.5% (Sabuncuoglu et al., 2015), 2% (Sarhan et al., 2016), 3.7% (Kose et al., 2017), 3.3% (Sabry et al., 2018) and 7.4% (Abdelnaby et al., 2018), respectively (Table 1). Discussion and Conclusion: Recurrence rates after modified Limberg flap procedure for the treatment of pilonidal disease vary between 0%-10%. Dispersion of the pits in the gluteal sulcus, various flap sizes, hairiness of the gluteal region, prior wound infection within the operation field, different lateralization distances of the flaps from the midline, post-operative wound care, immunosuppression, underreporting and a short follow-up period may play role in the outcomes after surgical treatment. A drawing template which was recommended by Yuksel et al. in 2019 may help to standardize modified Limberg flap procedure in order to facilitate the comparison of end results accurately. Keywords: Flap, Limberg, Modified, Pilonidal, Recurrence
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Frequently, patients identified as high risk for postoperative nausea and vomiting (PONV) are treated prophylactically with intravenous (IV) ondansetron and postoperatively with IV promethazine. The purpose of this study was to determine if using an aromatic therapy of 70% isopropyl alcohol (IPA) would be more effective than promethazine in resolution of breakthrough PONV symptoms in groups of high-risk patients administered prophylactic ondansetron. All subjects enrolled were identified as high risk for PONV, administered general anesthesia and a prophylactic antiemetic of 4 mg of IV ondansetron, and randomized to receive IPA or promethazine for treatment of breakthrough PONV Demographics, verbal numeric rating scale (VNRS) scores for nausea, time to 50% reduction in VNRS scores, and overall antiemetic and incidence of PONV were measured. The data for 85 subjects were included in analysis; no differences in demographic variables or baseline measurements were noted between groups. The IPA group reported a faster time to 50% reduction in VNRS scores and decreased overall antiemetic requirements. A similar incidence in PONV was noted between groups. Based on these findings, we recommend that inhalation of 70% IPA is an option for treatment of PONV in high-risk patients who have received prophylactic ondansetron.
All obtainable investigations that have compared the incidence of vomiting in groups of patients who received nitrous oxide (N2 O) and in patients who received anesthetics or analgesics without N2 O were examined for a single, dichotomous variable:whether patients who received N2 O experienced an absolutely higher incidence, as distinct from a statistically significantly higher incidence, of vomiting. The null hypothesis is that N2 O has no effect on emesis, such that an increased incidence of vomiting should occur in about half of the studies examined. However, patients receiving N2 O experienced an absolutely higher incidence of emesis in 24 of 27 investigations. The two-tailed probability that this result occurred by chance is <0.00005. It follows that N2 O increases the incidence of emesis compared to alternative anesthetics. (Anesth Analg 1996;83:114-6)
Background: The mechanisms for postoperative nausea and vomiting are numerous and pathways not well elucidated. Although many medications have been developed to help prevent postoperative nausea and vomiting, the search for better approaches to recovery treatment continues. Objective: The purpose of this study was to evaluate the effectiveness of isopropyl alcohol (IPA) inhalation for treatment of postoperative nausea and vomiting for patients who have general anesthesia for a surgical procedure. Method: Participants were recruited from an urban hospital on the East Coast of the United States. Participants were assigned to an experimental or control group and IPA inhalation was compared to the standard anti-emetic treatment for rescue treatment in the immediate postoperative period. Postoperative nausea and vomiting was rated using a descriptive ordinal scale. Results: The results of this study show IPA to be effective and that there was no significant difference between the standard treatment protocol and treatment with IPA. Treatment with IPA was significantly more cost effective than standard drug treatment. Discussion: Further research is recommended to evaluate the length of effectiveness, standard dose needed, most effective mode of inhalation, and factors blocking IPA effectiveness.
This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty-five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001).
Postoperative nausea and vomiting is a common and unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as a possible addition to the available treatment strategies. This review sought to establish what effect the use of aromatherapy has on the severity and duration of established postoperative nausea and vomiting and whether aromatherapy can be used with safety and clinical effectiveness comparable to standard pharmacological treatments. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); MEDLINE; EMBASE; CINAHL; CAM on PubMed; Meditext; LILACS; and ISI Web of Science as well as grey literature sources and the reference lists of retrieved articles. We conducted database searches up to August 2011. We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) where aromatherapy was used to treat postoperative nausea and vomiting. Interventions were all types of aromatherapy. Aromatherapy was defined as the inhalation of the vapours of any substance for the purposes of a therapeutic benefit. Primary outcomes were the severity and duration of postoperative nausea and vomiting. Secondary outcomes were adverse reactions, use of rescue anti-emetics and patient satisfaction with treatment. Two review authors assessed risk of bias in the included studies and extracted data. As all outcomes analysed were dichotomous, we used a fixed-effect model and calculated relative risk (RR) with associated 95% confidence interval (95% CI). The nine included studies comprised six RCTs and three CCTs with a total of 402 participants. The mean age and range data for all participants were not reported for all studies. The method of randomization in four of the six included RCTs was explicitly stated and was adequate. Incomplete reporting of data affected the completeness of the analysis. Compared with placebo, isopropyl alcohol vapour inhalation was effective in reducing the proportion of participants requiring rescue anti-emetics (RR 0.30, 95% CI 0.09 to 1.00, P = 0.05). However, compared with standard anti-emetic treatment, isopropyl alcohol was not effective in reducing the proportion of participants requiring rescue anti-emetics (RR 0.66, 95% CI 0.39 to 1.13, P = 0.13) except when the data from a possibly confounded study were included (RR 0.66, 95% CI 0.45 to 0.98, P = 0.04). Where studies reported data on patient satisfaction with aromatherapy, there were no statistically significant differences between the groups (RR 1.12, 95% CI 0.62 to 2.03, P = 0.71). Isopropyl alcohol was more effective than saline placebo for reducing postoperative nausea and vomiting but less effective than standard anti-emetic drugs. There is currently no reliable evidence for the use of peppermint oil.
There is empirical evidence that smokers are less likely to suffer from postoperative nausea and vomiting (PONV). We sought to investigate whether transcutaneus nicotine prevents PONV. Non-smokers receiving general anaesthesia for surgery were randomly allocated to Nicotinell Patch 10cm(2) (TTS 10), containing 17.5mg of nicotine (average delivery rate, 7mg 24h(-1) ) or matching placebo patch. Patches were applied 1h before surgery and were left in situ until 24h after surgery (or until the first PONV symptoms occurred). We randomized 90 patients (45 nicotine, 45 placebo). In the post-anaesthetic care unit, the incidence of nausea was 22.2% with nicotine and 24.4% with placebo (P= 0.80), and the incidence of vomiting was 20.0% with nicotine and 17.8% with placebo (P= 0.78). Cumulative 24h incidence of nausea was 42.2% with nicotine and 40.0% with placebo (P= 0.83), and of vomiting was 31.1% with nicotine and 28.9% with placebo (P= 0.81). PONV episodes tended to occur earlier in the nicotine group. Postoperative headache occurred in 17.8% of patients treated with nicotine and in 15.6% with placebo (P= 0.49). More patients receiving nicotine reported a low quality of sleep during the first postoperative night (26.7% vs. 6.8% with placebo; P= 0.01). Non-smokers receiving a prophylactic nicotine patch had a similar incidence of PONV during the first 24h and tended to develop PONV symptoms earlier compared with controls. They had a significantly increased risk of insomnia during the first postoperative night.
All obtainable investigations that have compared the incidence of vomiting in groups of patients who received nitrous oxide (N2O) and in patients who received anesthetics or analgesics without N2O were examined for a single, dichotomous variable: whether patients who received N2O experienced an absolutely higher incidence, as distinct from a statistically significantly higher incidence, of vomiting. The null hypothesis is that N2O has no effect on emesis, such that an increased incidence of vomiting should occur in about half of the studies examined. However, patients receiving N2O experienced an absolutely higher incidence of emesis in 24 of 27 investigations. The two-tailed probability that this result occurred by chance is < 0.00005. It follows that N2O increases the incidence of emesis compared to alternative anesthetics.
Postoperative nausea and vomiting (PNV) is a common disorder at the forefront of ambulatory care issues. New antiemetic drugs and improved anesthetic techniques have decreased the incidence of anesthesia-induced PNV. Patient characteristics and surgical factors are now largely responsible for postoperative emesis. Clinicians need to understand these factors to deal effectively with PNV as the use of ambulatory surgery increases. Physicians should consider both prophylactic drug intervention and direct treatment.
Postoperative nausea and vomiting (PONV) is an age-old problem; more so since the blooming of ambulatory or day surgery centres within the last 2 decades. The aetiology of PONV is multifactorial. The incidence of PONV is usually higher in women and children than in men. PONV not only causes patient discomfort, anxiety in mild cases, and serious complications in severe cases, it also decreases cost efficiency. The benefits and risks of old and new antiemetic drugs used worldwide to treat PONV are discussed in this article, including the newly developed serotonin 5-hydroxytryptamine 3 (5HT3) antagonists. All the medications currently used to treat PONV have both advantages and disadvantages. If used indiscriminately to treat patients who have no problems with PONV, the risks of adverse effects often outweigh the benefits. The patient’s history and the nature of the surgery are good indicators for defining those at risk from PONV; for patients at risk preventive treatment is essential. However, it is almost impossible to pick one agent or one combination as the therapy of choice using the present available data. A patient history of a favourable response to a previously used antiemetic would make that drug the agent of choice, So far, the newcomers, the 5HT3 antagonists, have fewer reported adverse effects.