Effects of French Lavender Aromatherapy on Post-Appendectomy Pain

Effects of French Lavender Aromatherapy on Post-Appendectomy Pain

Abstract

• Background: Postoperative pain is unavoidable due to tissue damage stimulating the central nervous system.
• Objectives: To investigate the effects of French lavender on post-appendectomy pain and medication use.
• Methods: Randomized clinical trial with 120 patients undergoing acute abdominal surgery.
  • Intervention group inhaled lavender essential oil.
  • Placebo group inhaled almond oil.
  • Pain measured using the Visual Analogue Scale (VAS) at baseline, 30 minutes after the first intervention, and after the second and third interventions.
• Results:
  • Lavender aroma significantly reduced pain at all stages (P < 0.0001).
  • Pain intensity significantly lower in the intervention group than the control group (P < 0.0001).
• Conclusions: Aromatherapy is an effective complementary option to reduce postoperative pain and analgesic drug use.
• Keywords: Aromatherapy, French Lavender, Pain Analgesics, Abdominal Surgery

1. Background

• Postoperative pain is unavoidable due to surgical interventions causing tissue damage and stimulating the central nervous system (1).
• A study in the Netherlands found that 41% of hospitalized patients experienced moderate to severe pain on the day of surgery, and 15% continued to experience it for up to four days post-surgery (2).
• Untreated postoperative pain can lead to adverse physiological consequences (3), including:
  • Respiratory distress
  • Sympathetic system activation
  • Increased blood coagulability (4)
  • Increased heart rate, respiration, and sweating
  • Reduced arterial oxygen
  • Increased levels of aldosterone and antidiuretic hormone
  • Water and sodium retention, leading to reduced urine output (5)
  • Skin irritation, restlessness, and pupillary dilatation (6)
  • Delayed recovery
  • Impairment of immune function, movement, and sleep patterns
  • Loss of appetite (7)
• Postoperative pain also affects mental health, increasing fear, anxiety, feelings of helplessness, and hopelessness (8).
• Caregivers must be aware of stressful factors in hospitalization and utilize safe, effective interventions to reduce stressors and provide non-traumatic care (3).
• Controlling post-appendectomy pain is a key aspect of postoperative nursing care.
• While narcotics and tranquilizers can reduce pain, they have adverse effects such as drowsiness, nausea, vomiting, constipation, respiratory system inhibition, central nervous system depression, addiction, fatigue, confusion, or restlessness (8, 9).
• New regulatory standards emphasize routine pain assessment as the fifth vital sign (2).
• Non-pharmacological approaches like complementary and alternative medicine, particularly aromatherapy, are gaining attention (9).
• Aromatherapy involves inhaling vapors or absorbing essential oils through the skin to treat emotional and physical symptoms (9).
• Early studies suggest aromatherapy reduces stress, pain, and depression (9).
• Essential oil extracts like lavender, jasmine, rosemary, rose, geranium, and chamomile are used for pain and anxiety (9).
• Aromatherapy significantly reduced pain after cesarean section in one study (11).
• However, the therapeutic use of aromatherapy is controversial due to limited scientific evidence on its effectiveness and safety (9).
• Lavender, an aromatic herb with analgesic effects, has gained attention (12).
  • Linalool and linalyl acetate in lavender stimulate the parasympathetic system.
  • Linalyl acetate has narcotic properties, and linalool acts as a sedative (13, 14).
• Review studies have reported that evidence is not sufficient to decide whether aromatherapy can reduce pain and psychological suffering (15).
• A study by Bagheri-Nezam et al. showed more pain relief with lavender aromatherapy compared to a control group (16).

2. Objectives

• The study aims to evaluate the effect of French lavender aromatherapy, using the inhalation technique, on reducing pain and the need for narcotic drugs after appendectomy surgery.
• Aimed to introduce aromatherapy as a new and easy alternative to reduce postoperative pain and the demand for narcotic drugs.

3. Methods

3.1. Study Design and Samples

• Single-blind randomized clinical trial conducted on 120 patients undergoing acute abdominal surgery at Shohadaye Assayer Hospital in Khorramabad from 2009 to 2010.
• Participants were recruited non-randomly and consecutively.
• Patients were divided into three groups (intervention, placebo, and control) via blocked randomization to ensure homogeneity regarding gender, age, type of operation, prescribed medicine, and type of surgery (elective, emergency, or urgent).

3.2. Inclusion Criteria

• Inclusion criteria:
  • Aged 18-65 years.
  • Undergoing abdominal surgery with operation duration less than 90 minutes.

3.3. Exclusion Criteria

• Exclusion criteria:
  • Drug addiction
  • Chronic diseases or diabetes
  • More than one surgery
  • Cancer diagnosis
  • History of eczema or allergy to herbs
  • History of migraine or chronic headaches
  • Hemorrhagic disease or active mental illness
  • Disorders of the olfactory system

3.4. Blinding

• Researcher unaware of scent type, classifying the study as single-blind.

3.5. Randomization

• Blocked randomization method used (using https://www.sealedenvelope.com/simple-randomiser/v1/5).
• 5 blocks of 10 and 10 blocks of 7 were selected.
• Patients divided into three groups:
  • Treatment (40 patients, lavender)
  • Control (40 patients, no treatment)
  • Placebo (40 patients, almond oil).

3.6. Intervention

• First pain assessment using Visual Analogue Scale (VAS) was done 6-8 hours post-surgery, at least three hours after analgesic medication (pain 1).
• Lavender essential oil preparation:
  • French lavender flowers collected; essential oil prepared by a chemist in pure form.
  • Oil combined with one-tenth sweet almond oil (no aroma) to reduce volatility and add aroma.
  • Resulting essential oil stored at -20°C.
• Intervention:
  • Intervention group: Two drops of the mixture on a handkerchief, held 2.5-5 cm from the patient's nose, inhaled for 3 minutes.
  • Pain measured again after half an hour (pain 1.1).
  • Placebo group: Two drops of almond oil on a handkerchief; pain measured using VAS.
  • Patients of each group hospitalized in different rooms.
• Second stage:
  • After 6-8 hours, pain measured again (pain 2), intervention repeated.
  • Pain measured again after half an hour (pain 2.2).
• Third intervention:
  • Provided 6-8 hours after the second stage (pain 3), pain measured half an hour later (pain 3.3).
• Participants evaluated for pain medication received.
  • Analgesic drugs: narcotic and non-opioid analgesics administered after leaving the recovery unit and in the first 24 hours post-surgery.
  • Dose, type, and method of administration recorded (Figure 1).

3.7. Data Collection

• General information (age, sex, surgeon, pre-operative discontinuation of medications, pain tolerance threshold) collected via questionnaire.
• Pain measured using the Visual Analogue Scale (VAS).
• Received analgesic drugs within the first 24 hours after surgery obtained from medical records.
• Data collected using demographic questionnaire, VAS, and medical records.

3.8. The Reliability and Validity of the Data Collection Instruments

• VAS is a 10 cm line to measure pain, from zero (“no pain”) to 10 (