Aromatherapy for treatment of postoperative nausea and vomiting

Sonia Hines; Elizabeth Steels; Anne Chang; Kristen Gibbons

doi:10.1002/14651858.CD007598.pub2

Cochrane Database of Systematic Reviews

Aromaterapia para el tratamiento de las náuseas y los vómitos posoperatorios

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DOI:

https://doi.org/10.1002/14651858.CD007598.pub2 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

18 abril 2012see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Anestesia

Copyright:

Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Sonia Hines

Correspondencia a: Mater Nursing Research Centre, Queensland Centre for Evidence‐Based Nursing & Midwifery, A Collaborating Centre of the Joanna Briggs Institute, South Brisbane, Australia

[email protected]

[email protected]
Elizabeth Steels

Faculty of Health Sciences, Australian College of Natural Medicine, Brisbane, Australia
Anne Chang

Mater Nursing Research Centre, Queensland Centre for Evidence‐Based Nursing & Midwifery, A Collaborating Centre of the Joanna Briggs Institute, South Brisbane, Australia
Kristen Gibbons

Clinical Research Support Unit, Mater Medical Research Institute, South Brisbane, Australia

Contributions of authors

Conceiving the review: Sonia Hines (SH)

Designing the review: SH

Co‐ordinating the review: SH

Undertaking manual searches: SH

Screening search results: SH, Elizabeth Steels (ES)

Organizing retrieval of papers: SH

Screening retrieved papers against inclusion criteria: SH, ES

Appraising quality of papers: SH, ES, Anne Chang (AC)

Abstracting data from papers: SH, ES, Kirsten Gibbons (KG)

Writing to authors of papers for additional information: SH

Providing additional data about papers: SH, AC

Obtaining and screening data from unpublished studies: SH, ES

Data management for the review: SH

Entering data into Review Manager (RevMan 5.1): SH, KG

Analysis of data: SH, ES, KG

Interpretation of data: SH, ES, AC, KG

Writing the review: SH, AC, KG

Securing funding for the review: SH

Performing previous work that was the foundation of the present study: SH

Guarantor for the review (one author): SH

Statistical analysis: KG, AC

Sources of support

Internal sources

Nursing Research Centre, Mater Health Services, Australia.

Time and facilities.

External sources

Queensland Health, Australia.

Nursing and Midwifery Research Grant ($5906) awarded to Sonia Hines

Declarations of interest

Sonia Hines: Queensland Health Nursing and Midwifery Research Grant received by Sonia Hines to assist with the conduct of the review (AUD 5906). The granting body had no influence on the findings of this review.

All other authors: no conflict of interest is known.

Acknowledgements

We thank Mathew Zacharias, Jung T Kim, NL Pace, Peter Kranke and Anne Lyddiatt for their help and advice during the preparation of the systematic review.

We also thank Mathew Zacharias, Katrina Farber, Milli Reddy, Jung T Kim and Janet Wale for their help and editorial advice during the preparation of the protocol for the systematic review.

The authors wish to acknowledge Kathy Hibberd (Librarian, University of Queensland Medical Library) for her invaluable assistance in preparing and conducting the searches for this review, and Leandra Blake for her comments on the protocol and review. We also thank Kate Kynoch and Lisa Brown for assisting with the testing of the data extraction tool.

Thanks to Marie Kristensson for the Swedish translations, Abbas Breesem for the Farsi translation, and Laurie Bay at the Institute of Modern Languages at the University of Queensland for the French translation.

Version history

Published

Title

Stage

Authors

Version

2018 Mar 10

Aromatherapy for treatment of postoperative nausea and vomiting

Review

Sonia Hines, Elizabeth Steels, Anne Chang, Kristen Gibbons

https://doi.org/10.1002/14651858.CD007598.pub3

2012 Apr 18

Aromatherapy for treatment of postoperative nausea and vomiting

Review

Sonia Hines, Elizabeth Steels, Anne Chang, Kristen Gibbons

https://doi.org/10.1002/14651858.CD007598.pub2

2009 Jan 21

Aromatherapy for treatment of postoperative nausea and vomiting

Protocol

Sonia Hines, Elizabeth Steels, Anne Chang, Kristen Gibbons

https://doi.org/10.1002/14651858.CD007598

Differences between protocol and review

The original protocol stated "We will judge the study quality using a validated critical appraisal checklist developed by the Joanna Briggs Institute and based on the work of The Cochrane Collaboration and the Centre for Reviews and Dissemination (Figure 2). This checklist assesses selection, allocation, treatment, and attrition biases". Due to changes in the Cochrane requirements, we have used the Cochrane risk of bias assessment instead.

We had originally planned to search the website http://www.nhmrc.gov.au/nics/asp/index.asp, however this no longer exists and http://www.nhmrc.gov.au/nics/index.htm was searched instead.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

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.

Figure 1

Results of searches

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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Analysis 1.1

Comparison 1 Isopropyl alcohol versus standard treatment for PONV, Outcome 1 Proportion requiring rescue anti‐emetics.

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Analysis 2.1

Comparison 2 Isopropyl alcohol versus standard treatment for PON: sensitivity analysis, Outcome 1 Proportion requiring rescue anti‐emetics.

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Analysis 3.1

Comparison 3 Isopropyl alcohol versus standard treatment for PON, Outcome 1 Proportion requiring rescue anti‐emetics.

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Analysis 4.1

Comparison 4 Isopropyl alcohol versus saline, Outcome 1 Proportion requiring rescue anti‐emetics.

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Analysis 5.1

Comparison 5 Aromatherapy versus standard anti‐emetics, Outcome 1 Patient satisfaction.

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Summary of findings for the main comparison. Isopropyl alcohol compared to standard treatment for treatment of postoperative nausea and vomiting

Isopropyl alcohol compared to standard treatment for treatment of postoperative nausea and vomiting
Patient or population: patients with treatment of postoperative nausea and vomiting Settings: Post‐anaesthesia Care Areas Intervention: Isopropyl alcohol Comparison: Standard treatment
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Standard treatment	Isopropyl alcohol
Requirement for rescue anti‐emetics	Study population¹		RR 0.66 (0.45 to 0.98)	215 (4 studies)	⊕⊕⊝⊝ low^2,3
	392 per 1000	259 per 1000 (176 to 384)
	Medium risk population¹
	275 per 1000	182 per 1000 (124 to 270)
Adverse effects⁴	See comment	See comment	Not estimable	0 (0)	See comment
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Calculated using control group results. ² Study by Merritt (2002) was not adequately randomised. ³ Total number of events is less than 300. ⁴ No data on this outcome.

Summary of findings for the main comparison. Isopropyl alcohol compared to standard treatment for treatment of postoperative nausea and vomiting

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Summary of findings 2. Isopropyl alcohol compared to saline for treatment of postoperative nausea and vomiting

Isopropyl alcohol compared to saline for treatment of postoperative nausea and vomiting
Patient or population: patients with treatment of postoperative nausea and vomiting Settings: Post‐anaesthesia Care Areas Intervention: Isopropyl alcohol Comparison: saline
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	saline	Isopropyl alcohol
Requirement for rescue anti‐emetics^1,2 count	Study population³		RR 0.23 (0.14 to 0.38)	135 (3 studies)	⊕⊕⊝⊝ low^4,5
	868 per 1000	200 per 1000 (122 to 330)
	Low risk population³
	100 per 1000	23 per 1000 (14 to 38)
Adverse effects⁶	See comment	See comment	Not estimable	0 (0)	See comment
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Participants enrolled into study on complaint of nausea and/or vomiting. ² Calculated using control group results. ³ Risk calculations based on: Pierre S, Benais H, Pouymayou J. Apfel's simplified score may favourably predict the risk of postoperative nausea and vomiting. Canadian Journal of Anesthesia / Journal Canadien d'Anesthesie. 2002;49(3):237‐42. ⁴ Study by Langevin (1997) is controlled clinical trial and not randomised. ⁵ Total number of events is less than 300. ⁶ No data on this outcome.

Summary of findings 2. Isopropyl alcohol compared to saline for treatment of postoperative nausea and vomiting

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Table 1. Table 1. Studies measuring time to relief of nausea

Study	Design	Intervention/Control	Outcome	Findings
Cotton 2007	RCT	IPA/ondansetron	Time to 50% reduction in nausea (VNRS¹)	IPA: mean 15.00 (SD:10.6mins) Ondansetron: mean 33.88 (SD: 23.2mins)
Kamalipour 2002	RCT	IPA/saline	Percentage "response"² to treatment within 5 minutes	IPA: 78% Saline: 7.3%
Langevin 1997	CCT	IPA/saline	Percent with complete relief of nausea in 5 minutes	IPA: 80% Saline: 0%
Pellegrini 2009	RCT	IPA/Promethazine	Mean time to 50% reduction in nausea scores (VNRS¹)	IPA: (mean +/‐ SD) PACU³: 6.43 +/‐ 3.78 minutes SDSU⁴: 8.33 +/‐ 4.82 minutes HOME⁵: 16.58 +/‐ 6.9 minutes Promethazine: (mean +/‐ SD) PACU³: 20.5 +/‐ 18.236 minutes SDSU⁴: 23.3 +/‐ 18.86 minutes HOME⁵: 26.67 +/‐ 12.5 minutes
Winston 2003	RCT	IPA/ondansetron	Mean time to 50% reduction of VNRS¹	IPA: 6.3 minutes Ondansetron: 27.7 minutes
¹VRNS: Verbal Numeric Rating Scale. ²Meaning of response not defined by study authors. ³PACU: Postanaesthesia Care Unit. ⁴SDSU: Same Day Surgery Unit. ⁵Home: Participant's residence post‐discharge.

Table 1. Table 1. Studies measuring time to relief of nausea

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Table 2. Table 2. Studies measuring a decrease in nausea scores

Study	Design	Intervention/Control	Outcome	Findings
Merritt 2002	CCT	IPA/standard anti‐emetics	Decrease in mean nausea score (DOS¹) 0‐10 (0 = no nausea, 10 = worst nausea and vomiting imaginable)	IPA: Mean DOS¹ score Pre‐treatment: 5.71 Post‐treatment: 2.7 Standard treatment: Pre‐treatment: 6.11 Post‐treatment: 1.94
Tate 1997	CCT	Peppermint oil/peppermint essence/standard treatment	Mean daily nausea scores (DOS¹) 0‐4 (0 = no nausea, 4 = about to vomit)	Standard treatment: mean daily nausea score = 0.975 Peppermint essence mean daily nausea score (placebo): 1.61 Peppermint oil mean daily nausea score: 0.5
Wang 1999	RCT	IPA/saline	Percentage of participants with decrease in nausea after 3 treatments (VAS) 0‐100 (0 = no nausea, 100 = extreme nausea)	IPA: 91% Saline: 40%
¹DOS: Descriptive Ordinal Scale.

Table 2. Table 2. Studies measuring a decrease in nausea scores

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Table 3. Patient satisfaction

Study	Design	Intervention/Comparison	Measure	Satisfied
Cotton 2007	RCT	IPA/ondansetron	4‐point DOS (poor, fair, good, excellent)	Good or excellent: Intervention: 38/38 Comparison: 34/34
Winston 2003	RCT	IPA/ondansetron	4‐point DOS (poor, fair, good, excellent)	Good or excellent: Intervention: 38/50 Comparison: 30/50
Pellegrini 2009	RCT	IPA/Promethazine	5‐point DOS (1 = totally unsatisfied, 5 = totally satisfied)	Both groups report median score 4
Anderson 2004	RCT	IPA/Saline/Peppermint	100mm VAS (0 mm extremely dissatisfied; 100 mm fully satisfied)	IPA: 90.3 (SD: 14.9) peppermint: 86.3 (SD: 32.3) saline: 83.7 (SD: 25.6)

Table 3. Patient satisfaction

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Comparison 1. Isopropyl alcohol versus standard treatment for PONV

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Proportion requiring rescue anti‐emetics Show forest plot	4	215	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.45, 0.98]

Comparison 1. Isopropyl alcohol versus standard treatment for PONV

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Comparison 2. Isopropyl alcohol versus standard treatment for PON: sensitivity analysis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Proportion requiring rescue anti‐emetics Show forest plot	3	176	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.39, 1.13]

Comparison 2. Isopropyl alcohol versus standard treatment for PON: sensitivity analysis

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Comparison 3. Isopropyl alcohol versus standard treatment for PON

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Proportion requiring rescue anti‐emetics Show forest plot	3	176	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.39, 1.13]

Comparison 3. Isopropyl alcohol versus standard treatment for PON

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Comparison 4. Isopropyl alcohol versus saline

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Proportion requiring rescue anti‐emetics Show forest plot	3	135	Risk Ratio (M‐H, Random, 95% CI)	0.30 [0.09, 1.00]

Comparison 4. Isopropyl alcohol versus saline

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Comparison 5. Aromatherapy versus standard anti‐emetics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Patient satisfaction Show forest plot	2	172	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.62, 2.03]

Comparison 5. Aromatherapy versus standard anti‐emetics

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Aromaterapia para el tratamiento de las náuseas y los vómitos posoperatorios

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