eTable 2. Effect of perioperative or postoperative aromatherapy on anxiety, stress, pain, nausea, vomiting, and sleep quality.
| Reference *1 | Year | Intervention | N | Patients | Surgery | Type/quality | Results |
| Symptom: Anxiety and stress | |||||||
| (e24) | 2011 | Preoperative inhalation of lavender oil or water | 72 | Adults | Cardiac and general surgery | Quasi-experimental study, quality*2: bad |
STAI (intervention vs. placebo): −12.4 vs. −2.4 pts (p <0.01) |
| (e33) | 2012 | Postoperative massage with mandarin oil (A), carrier oil (B), or no intervention (C) |
60 | Children up to 3 years |
Craniofacial surgery |
RCT, quality*2: bad |
COMFORT-B (groups A / B / C):11.1 / 11.6 / 12.1 pts; NAS (stress): 2 / 4 / 3 pts; NAS (pain): 1 / 0 / 1 pt (p not given) |
| (e58) | 2013 | Aroma diffuser with bergamot oil or placebo | 109 | Adults | Ambulatory surgery |
RCT, quality*2: good |
STAI (intervention vs. placebo): −3 vs. −2 pts (p = 0.02) |
| (e65) | 2014 | Inhalation on the 2nd and 3rd postoperative days of lavender oil versus water | 60 | Adults | Cardiac surgery | RCT, quality*2: good |
STAI (intervention vs. placebo): before intervention : 48.73 vs. 48 pts; after intervention 42.6 vs. 42.73 pts, on 3rd postoperative day: 41.33 vs. 41.56 pts (p not significant at any point) |
| (e72) | 2017 | Preoperative inhalation of lavender essential oil versus no intervention |
100 | Adults | Ambulatory ENT surgery |
Controlled study, quality*2: bad |
Anxiety reduction according to VAS (intervention vs. control): −1.07 vs. −0.01 (p <0.01) |
| (e69) | 2017 | Aromatherapy during biopsy with lavender-sandalwood (A), orange-peppermint (B), or placebo (C) |
87 | Women | Breast biopsy | RCT, quality*2: bad | STAI: group A, from 48 to 37 pts; group B, from 43 to 37 pts; group C, from 43 to 39 pts; difference A vs. C, p = 0.03 |
| (e13) | 2018 | Preoperative massage with lavender oil or no intervention |
80 | Adults | Colorectal surgery | RCT, quality*2: bad | STAI (intervention vs. control): 35.25 vs. 45.40 pts on morning of surgery (p <0.01) |
| Symptom: Pain | |||||||
| (e39) | 2016 | Postoperative inhalation of lavender oil or oxygen |
50 | Women | Breast biopsy | RCT, quality*2: bad | NAS (Intervention vs. control): 5 min after arrival on ward 0.2 vs. 1.26 pts, after 30 min 0.6 vs. 1.1 pts, after 60 min 0.6 vs. 1.42 pts; emergency medication required: 1 vs. 6; excellent satisfaction with pain control: 92% vs. 52% (p <0.05) |
| (e38) | 2006 | Postoperative inhalation of lavender oil or baby oil | 54 | Adults | Bariatric surgery | RCT, quality*2: bad | Need for anesthesia (intervention vs. control): 42% vs. 82% (p <0.01); use of anesthesia (intervention vs. control): 2.38 mg vs. 4.26 mg morphine (p = 0.04) |
| (e27) | 2011 | Perioperative inhalation of lavender oil or neutral oil | 200 | Women | Cesarean | RCT, quality*2: bad | VAS (intervention vs. control): baseline 6.16 vs. 5.78, after 30 min 3.67 vs. 5.29 (p <0.01), after 8 h 2.01 vs. 4.64 (p <0.01), after 16 h 0.67 vs. 4.05 (p <0.01) |
| (e67) | 2013 | Postoperative inhalation of lavender oil or no intervention | 48 | Children (6–12 years) |
Tonsillectomy | RCT, quality*2: bad | Number of oral paracetamol doses (intervention vs. control): 1st day, 2.1 vs. 2.6 (p <0.05), 2nd day: 2.1 vs. 3.4 (p <0.01), 3rd day: 1.3 vs. 2.4 (p <0.01) vas: 1st day, 7.0 vs. 7.6 pts, 2nd day: 6.8 vs. 7.0 pts, 3rd day 3.9 vs. 5.9 pts (p not given) |
| (e63) | 2014 | Postoperative inhalation of lavender oil | 40 | Adults | Cardiac surgery | Single-arm study, quality*2: bad; no control group | NAS reduction: from 5.6 to 5.0 pts after lavender inhalation (p not significant) |
| (e7) | 2014 | Massage of different body regions with eucalyptus-lemon oil (A), neutral oil (B), or no intervention (C) |
60 | Adults | Vitrectomy | RCT, quality*2: good |
FPS, day 1 (for groups A / B / C): shoulder: −1.1 / −0.8 / +0.15 pts; neck: −0.85 / −0.8 / +0.15 pts; back: −0.75 / −0.6 / +0.3 pts; waist: −0.9 / −1 / +0.1 pts; arms: −0.85 / −0.05 / −0.05 pts (p not given); pain reduction also observed on days 2 and 3 (data not shown) |
| (e11) | 2015 | Inhalation on 2nd postoperative day of lavender oil or oxygen | 50 | Adults | Cardiac surgery | RCT, quality*2: bad |
VAS (intervention / placebo): baseline, 5.62 / 6.27 pts; after 5 min, 4.26 / 6.23 pts (p <0.01); after 30 min, 4.39 / 6.3 pts (p <0.01); after 60 min, 4.11 / 6.35 pts (p <0.01) |
| (e53) | 2015 | Postoperative inhalation of rose oil or almond oil | 64 | Children (3–6 years) |
Mixed | RCT, quality*2: bad |
TPPPS (intervention / placebo) directly at arrival on ward: 3.8 vs. 3.1 pts, after 3 h: 1.0 / 2.6 pts, after 6 h: 1.03 vs. 2.03 pts, after 9 h: 0.9 / 1.6 pts, after 12 h 0.4 / 1.1 pts (p <0.01 for all time points) |
| Symptom: Nausea and vomiting | |||||||
| (e9) | 2004 | Inhalation (upon request) of peppermint, propanol, or NaCl | 33 | Adults | Ambulatory surgery |
RCT, quality*2: bad |
VAS (for all therapies): −1.79 pts (p <0.05), but not difference between the groups |
| (e31) | 2011 | Inhalation (upon request; using an aroma pad) of mix of ginger, spearmint, peppermint and cardamom (A) vs. ginger alone vs. isopropyl alcohol vs. NaCl | 303 | Adults | Gynecologic abdominal surgery |
RCT, quality*2: bad |
Ginger (OR = 1.86 [95% CI: (1.22; 3.0), p <0.01]) or mix (or = 2.7 [95%-ci: (1.78; 4.56), p <0.01]) better than nacl or alcohol (95% ci: [1.08; 2.13], p = 0.02; 95% ci: [1.5; 3.17], p <0.01) for nausea and need for antiemetics (95% ci: [−43.1; −8], p = 0.02; 95% ci: [−57.8; −22.7], p <0.01) |
| (e25) | 2012 | Inhalation (upon request) of peppermint oil or NaCl, or treatment with Zofran | 71 | Women | Mixed | RCT, quality*2: bad |
VAS (1–20, peppermint / NaCl / Zofran): before intervention: 12.5 / 11.9 / 11.3 pts; after 5 min: 8.0 / 7.5 / 6.8 pts; after 10 min: 2.4 / 3.4 / 5.8 pts (p not significant at any time point) |
| (e42) | 2012 | Inhalation of peppermint oil or placebo, or treatment with standard antiemetics | 35*3 | Women | Cesarean | RCT, quality*2: bad |
Reduction of nausea and vomiting for 17 out of 19 patients at 2 min and 5 min after peppermint treatment; no improvement after placebo or anti‧emetics (at either 2 min or 5 min) |
| (e1) | 2018 | Perioperative inhalation of different aromatic oils (including peppermint) or placebo | 402 | Mixed | Mixed | Systematic review, quality*2: high |
General aromatherapy vs. placebo: SMD = −0.22 (95% CI: [−0.63; 0.18], p = 0.28; reduced need of antiemetic treatment after aromatherapy: RR = 0.60 (95% CI: [0.37; 0.97], p =0.04; peppermint inhalation vs. placebo: SMD = −0.18 (95% CI: [−0.86; 0.49], p = 0.59 |
| (e30) | 2014 | Inhalation for nausea (upon request) of spearmint, peppermint, lavender, and ginger vs. placebo | 339 | Adults | Mixed | RCT, quality*2: bad |
Nausea for 121 Patienten, of whom 94 were randomized (54 intervention, 40 placebo); NAS (intervention / placebo): initial 5.4 / 5.6 pts, after use 3.4 / 4.4 pts (p = 0.03) |
| (e8) | 2015 | Postoperative inhalation (2 drops every 30 min, aroma pad) of ginger extract or NaCl | 120 | Adults | Nephrectomy | RCT, quality*4: bad |
VAS (intervention / placebo): 7.1 / 7.4 pts after 30 min, 4.2 / 7.4 pts after 60 min, 2.4 / 7.4 pts after 90 min, 2.0 / 7.4 after 120 min, 1.1 / 6.5 after 6 h (for all, p <0.01); need for ondansetron: 1.9 / 3.9 mg (p <0.01) |
| (e54) | 2015 | Inhalation (upon request) of spearmint, peppermint, lavender, and ginger | 70 | Adults | Ambulatory surgery |
Exploratory study, quality*4: bad; no control group |
Nausea reported for 25 patients; NAS (after use), −4.78 pts (p not given) |
| (e47) | 2017 | Postoperative inhalation of ginger oil or NaCl | 60 | Adults | Abdominal surgery |
Quasi-experimental study, quality*4: bad | RINVR (intervention / placebo): 11.8 / 11.57 pts (baseline), 1.6 / 10.47 pts after 6 h, 1.0 / 9.07 pts after 12 h, 0.83 / 7.2 pts after 24 h; lower pts after intervention (p <0.01) |
| (e37) | 2016 | Inhalation for nausea of lavender, menthol, ginger, or NaCl | 80 | Children (4–16 years) |
Ambulatory surgery | RCT, quality*2: good |
BARF (intervention / placebo): reduction by 2 pts, 90% / 78%; use of antiemetic therapy, 52% / 44%; vomiting, 9% / 11% (p not significant in any case) |
| Improvement of sleep quality | |||||||
| (e36) | 2017 | Postoperative massage with lavender oil or no intervention | 60 | Adults | General surgery | Experimental study, quality*4: bad |
RCSF: increase of 25.72 pts (p <0.01) (as compared to control) |
| (e13) | 2018 | Preoperative massage with lavender oil or no intervention | 80 | Adults | Colorectal surgery | Experimental study, quality*4: bad |
RCSF: increase of 24.02 pts (p <0.01) (as compared to control) |
*1 See eReferences; *2 Calculated according to the Jadad score scale; *3 Unbalanced group sizes: of the 35 patients, 22 were in the intervention group, 8 in the placebo group, and 5 in the standard therapy group; *4 Calculated according to the AMSTAR score scale BARF, Baxter Animated Retching Faces scale; CI, confidence interval; COMFORT-B, comfort behavior scale (pain, sedation) for young children; FPS, Faces Pain Scale; N, sample size; NaCl, sodium chloride saline solution; NAS, numeric analog scale (1– 10);
OR, odds ratio; pts, points; RCSF, Richard Campbell sleep questionnaire; RCT, randomized controlled trial; RINVR, Rhodes Index of Nausea, Vomiting, and Retching; RR, relative risk; SMD, standardized mean difference;
STAI, State-Trait Anxiety Inventory; TPPPS, Toddler-Preschooler Postoperative Pain Scale; VAS, Visual Analog Scale (1– 10)