Aromatherapy for Postoperative Nausea in Acute Care-Evidence and Future Opportunities.

Postoperative nausea (PON) is a common event associated with surgery and anesthesia. Despite the availability of 5-HT3 receptor antagonists and other agents, nausea and vomiting continue to be a difficult patient problem. Postoperative nausea is associated with discomfort, fatigue, and dehydration. Cost, patient dissatisfaction, and risks of aspiration provide ample evidence to explore additional ways to reduce PON burden. Nearly one-third of all persons undergoing surgery experience PON, and current medication interventions, although usually effective, often have sedation as adverse effect that can delay recovery, transfer, or discharge. Significant predictors for PON include female gender, history of motion sickness or PON, surgery procedure longer than 60 minutes, receiving volatile gas anesthesia, and gastrointestinal or gynecology surgery. Lack of consensus regarding best practices for antiemetic pharmacological agents opens a path to examine possible benefits of essential oil (EO) to reduce PON. Limited evidence suggests that noninvasive aromatherapy may provide relief at a low cost. Aromatherapy is defined as the therapeutic use of an EO; a complementary therapy. Evidence supporting aromatherapy for PON is weak related to limited numbers of trials withmethodological flaws.While well-designed trials are needed to validate the benefits of EO for relief of PON, limited evidence suggests that inhaled vapor of peppermint or ginger EO may reduce the frequency and severity of nausea and vomiting and decrease antiemetic medication requirements. In addition, aromatherapy appears to be linked to increased patient satisfaction. Aromatherapy provides a potential alternative therapy to manage nausea without medication adverse effects or sedation. Peppermint spirits (peppermint with an aromatic ethyl alcohol base) may be a useful adjunct. The aroma binds to receptors in the nasal epithelium, and neurochemical reactions are transmitted to the olfactory bulb, limbic system, and thalamus stimulating release of neurochemicals such as endorphins. Potential adverse effects can include allergies and mucous membrane irritation, and persons with lung conditions or pregnancy should avoid inhalation of oils. Peppermint has ancient roots in European medicinal arts. A hybrid of spearmint and water mint (Mentha aquatica), EO is brought forth by steam distillation of fresh aerial parts of the flowering plant. Peppermint oil has antiemetic and antispasmodic effects on the gastric lining and colon, which may be related to inhibition of muscular contractions induced by serotonin and substance P4. Inhaled as well as diluted topical application of EOs has a generally low toxicity profile and is not subject to approval by the Food and Drug Administration unless there is a specific claim for treatment of diseases. Essential oils can be provided via indirect inhalation using a room diffuser or drops of oil placed near the patient (eg, on a tissue or gauze). In a randomized trial of 303 subjects reporting nausea in an ambulatory surgical center, inhaled EO of ginger, or a blend of ginger, spearmint, peppermint, and cardamom EOs delivered via a gauze pad significantly reduced nausea (P = .002 and P G .001, respectively) comparedwith a saline placebo. Furthermore, requests for antiemetic medications significantly declined with ginger (P = .002) or the EO blend (P G .001) compared with placebo. In another study examining the effects of peppermint on nausea, 35 women postYcesarean delivery were randomly assigned to 3 groups; 1 group was provided peppermint spirits, the control group inhaled an inert placebo, and the standard-therapy group received standard medication Author Affiliation: Nurse Researcher, Center of Nursing Excellence, Premier HealthYMiami Valley Hospital, Dayton, Ohio. The author reports no conflicts of interest. Correspondence: Patricia Anne O’Malley, PhD, RN, CNS, PremierHealthY Miami Valley Hospital, 1 Wyoming St, Dayton, OH 45409 (pomalley@ premierhealth.com; pomalley5@woh.rr.com). DOI: 10.1097/NUR.0000000000000254