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Aromaterapija za liječenje postoperativne mučnine i povraćanja

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Abstract

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Data collection and analysis

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).

Main results

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).

Authors' conclusions

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.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Aromaterapija za liječenje mučnine i povraćanja nakon kirurškog zahvata

Postoperativna mučnina i povraćanje (POMP) je jako česta i neugodna nuspojava operacije. Čak 20% do 30% svih pacijenata pate od umjerene do teške mučnine i povraćanja nakon opće anestezije hlapljivim sredstvima (inhalacijska anestezija). Mučnina je nelagoda u trbuhu ili osjetljivost koja može biti popraćena povraćanjem (nasilno izbacivanje želučanog sadržaja kroz usta). Trenutne mogućnosti liječenja mučnine i povraćanja nakon operacije pomoću lijekova ne mogu uvijek biti učinkoviti ili mogu imati neugodne negativne učinke. Aromaterapija se ponekad preporučuje za liječenje mučnine i povraćanja, iako trenutno ne postoji dovoljno dokaza da je učinkovita. Aromaterapija koristi udisanje para esencijalnih ulja ili drugih tvari za liječenje ili ublažavanje fizičkih i emocionalnih simptoma. U ovom Cochrane sustavnom pregledu uključeno je devet studija o učinku aromaterapije na POMP, koje su imale ukupno 402 sudionika. Šest studija s kratkom inhalacijom para izopropilnog alkohola pokazale su da takav postupak može imati određeni učinak u smanjenju postoperativne mučnine i povraćanja; Međutim, čini se manje učinkovit od terapije standardnim lijekovima. Postoji mala opasnost od pristranosti zbog načina na koji su neke studije provedene. Izopropilni alkohol je također poznat kao alkohol za trljanje kože i obično se koristi za čišćenje kože prije injekcije. Trenutno nema pouzdanih dokaza koji podržavaju korištenje drugih aromaterapija poput ulja mente za liječenje postoperativne mučnine i povraćanja. Uključene studije nisu opisale bilo kakve negativne učinke korištenja aromaterapije.