Aromatherapy for treatment of postoperative nausea and vomiting

Sonia Hines; Elizabeth Steels; Anne Chang; Kristen Gibbons

doi:10.1002/14651858.CD007598.pub2

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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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