Herbal medications for anxiety, depression, pain, nausea and vomiting related to preoperative surgical patients: a systematic review and meta-analysis of randomised controlled trials

Ginger for treating nausea and vomiting: an overview of systematic reviews and meta-analyses

Ginger may be a potential remedy for nausea and vomiting. This review aimed to assess the reporting and methodological quality, and integrate the evidence in this field. A total of fifteen meta-analyses were analysed and met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines, providing a relatively complete statement. However, methodological quality, assessed using the Assessment of Multiple Systematic Reviews-2 checklist, was deemed critically low to low. Our review's findings support ginger's effectiveness in managing chemotherapy-induced nausea and vomiting in cancer patients. It also reduces postoperative nausea and vomiting severity, decreasing the need for rescue antiemetics. Furthermore, ginger shows promise in alleviating pregnancy-related nausea and vomiting symptoms. The pooled evidence suggests ginger as a safe botanical option for managing nausea and vomiting, but it is important to improve the scientific quality of published meta-analyses in the future.

Comparison of the Effects of Aromatherapy With Damask Rose and Chamomile Essential Oil on Preoperative Pain and Anxiety in Emergency Orthopedic Surgery: A Randomized Controlled Trial

PURPOSE

Patients who are awaiting emergency surgery experience high levels of anxiety and pain. This study aimed to compare the effects of aromatherapy with damask rose and chamomile essential oil on the preoperative pain and anxiety associated with emergency orthopedic surgery.

DESIGN

A parallel-group randomized controlled design was used.

METHODS

Ninety participants were selected and randomly assigned to three groups: the damask rose group (n = 30), the chamomile group (n = 30), and the control group (n = 30). In the damask rose and chamomile groups, three drops of 40% essential of each plant were used for inhalation aromatherapy (three drops every hour for 3 hours) Visual Analog Scales were used to evaluate participants' pain and anxiety levels at baseline, immediately after the intervention, and 1 hour after the intervention.

FINDINGS

The results of repeated measures Analysis of Variance (ANOVA) showed that both of the intervention groups experienced a decrease in pain and anxiety over time compared to the control group (P < .001). ANOVA results showed that immediately after the intervention, the anxiety level of the damask rose group compared to the chamomile and control groups was significantly lower (P = .01). However, there was no significant difference in terms of anxiety between the damask rose and chamomile groups 1 hour after the intervention (P = .07).

CONCLUSIONS

The use of damask rose and chamomile in aromatherapy was found to effectively lower anxiety and pain levels in emergency orthopedic surgery patients. The antianxiety effect of damask rose is faster than chamomile.

Chinese herbal medicine as adjuvant treatment for postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a protocol for systematic review and meta-analysis

INTRODUCTION

Postoperative nausea and vomiting (PONV) is a distressing symptom that patients often complain of even after less invasive surgery such as laparoscopic surgery (LS). If PONV is not well managed, patient recovery and postoperative quality of life are adversely affected. Although various drugs have been administered to prevent PONV, their effectiveness is limited, and adverse effects are numerous. Although herbal medicines have been widely used to manage various gastrointestinal symptoms, including nausea and vomiting, scientific evidence of their effects is lacking. This protocol is intended for a systematic review to analyse the efficacy and safety of Chinese herbal medicines for PONV after LS through a meta-analysis.

METHODS AND ANALYSIS

Randomised controlled trials, reported until June 2022, will be retrieved from electronic databases such as Medline, EMBASE and Cochrane Library. We will compare the effects of herbal medicine in patients presenting with PONV after LS with those of Western medicine, placebo and no treatment. If sufficient studies are identified, we will evaluate the combined effects of herbal and Western medicine. The incidence of nausea and vomiting will be considered the primary outcome. Secondary outcomes will include the intensity of complaints, quality of life and incidence of adverse events. Two independent reviewers will collect data based on the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, evaluate the quality of each study using the Cochrane risk-of-bias tool and synthesise the results via meta-analysis, if possible.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review. The results of this study will be disseminated to peer-reviewed journals and posters.

PROSPERO REGISTRATION NUMBER

CRD42022345749.

The preventive and relieving effects of ginger on postoperative nausea and vomiting: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Postoperative nausea and vomiting are common uncomfortable symptoms experienced by patients. Besides drugs, non-pharmaceutical therapies such as herbal medicine therapy are available. Ginger has played a therapeutic role in patients undergoing chemotherapy and pregnant women, but results from postoperative patients are inconsistent.

OBJECTIVES

The aim of this study was to examine and evaluate the preventive effect of ginger on postoperative nausea and vomiting.

DESIGN

A systematic review and meta-analysis of randomized controlled trials METHODS: Two independent researchers searched Chinese and English databases from their inception dates to November 2020. The Chinese databases used were CNKI and SinoMed, and the English databases used were PubMed, Embase, and the Cochrane Library. We only included randomized controlled trials. The primary outcomes were nausea score, presented as standard mean difference, and the number of vomiting episodes, presented as risk ratio. The secondary outcomes were side effects and antiemetic drug use, presented as risk ratios. We used the random-effects model.

RESULTS

Fourteen randomized trials with a total of 1,506 patients were pooled. At the different time points, the control group had higher postoperative nausea scores than the experimental group, and the differences were significant between the ginger and placebo groups at 2, 6, and 12 h after operation, with standard mean differences and 95% confidence intervals of -1.10 and -1.95 to -0.25, -1.54 and -3.05 to -0.03, and -2.04 and -3.67 to -0.41, respectively. Except in the recovery room, no statistically significant correlation was found between ginger intake and postoperative vomiting, postoperative nausea and vomiting, or antiemetic drug use.

CONCLUSION

The results of this meta-analysis demonstrate that ginger can reduce postoperative nausea but showed no significant difference in the incidence rates of postoperative vomiting, postoperative nausea and vomiting, and antiemetic drug use. More high-quality and rigorous trials are needed to elucidate the relationship between ginger intake and the reduction in the incidence of postoperative nausea and vomiting.

PROTOCOL REGISTRATION

CRD42020220916.

A Randomized Controlled Trial Examining the Effect of Aromatherapy Using the Damask Rose Essential Oil on Pre-operative Anxiety Levels

Background: Non-pharmacological care interventions like aromatherapy can be cost-effective and efficient ways to reduce anxiety and adverse results before surgery. Objectives: In this study, the efficacy of aromatherapy on pre-operative anxiety in patients undergoing Percutaneous Nephrolithotomy (PCNL) referring to Peymaniyeh Hospital in Jahrom-Iran was the main goal. Methods: This controlled-randomized trial was conducted on 38 patients that were randomly assigned to two groups: Control and Aromatherapy (Rosa damascena). The anxiety levels were recorded for all two groups the night before the surgery. On the day of surgery and after re-communication, patients were approached in a pre-operative holding area, and the intervention was performed. Data were collected over 11 months from June 2015 to May 2016. Results: The statistically significant difference after the intervention between the control and intervention groups indicated that Aromatherapy with Rosa damascene reduced the patient’s anxiety. Conclusions: This survey prepares evidence for the use of Damask rose as an anti-anxiety intervention. Using Damask rose as a nursing intervention helps nurses provide individualized care and helps patients control their anxiety.

The acupoint herbal plaster for the prevention and treatment of postoperative nausea and vomiting after PLIF with general anesthesia: study protocol for a multicenter randomized controlled trial

Background

Postoperative nausea and vomiting (PONV) are common in posterior lumbar intervertebral fusion (PLIF) patients undergoing general anesthesia. The previous clinical observation has shown that a traditional acupoint herbal plaster (AHP) is beneficial to patients with PONV. This trial aims to assess the effect of the AHP for the prevention and treatment of PONV after PLIF in patients with general anesthesia.

Methods

A multicenter, parallel, randomized controlled trial (RCT) will be conducted. A total of 166 participants will be randomized to either a treatment group receiving an AHP or a control groups receiving an acupoint placebo plaster (APP) in a 1:1 ratio. The primary outcomes are the first occurrence and frequency of nausea and vomiting. The secondary outcomes include the severity grading of nausea and vomiting using a visual analog scale (VAS) measurement system, quality of life, and serological indicators. The safety evaluation is mainly about adverse events and skin reactions’ observation. Assessments will be carried out at the baseline, day 1, and day 2 (the end of the intervention). The central randomization system in the clinical trial (http://124.205.181.142:8082/xwtf/) will be used to conduct random allocation.

Discussion

This scientific methodology design of the trial is expected to provide clinical evidence to support the AHP for the prevention and treatment of PONV.

Trial registration

This study is retrospectively registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on 19 April 2018. ID: ChiCTR1800015768.

Nutritional implications of ginger: chemistry, biological activities and signaling pathways

Ginger (Zingiber officinale Roscoe) has been used as a food, spice, supplement and flavoring agent and in traditional medicines due to its beneficial characteristics such as pungency, aroma, nutrients and pharmacological activity. Ginger and ginger extracts were reported to have numerous effects, such as those on diabetes and metabolic syndrome, cholesterol levels and lipid metabolism, and inflammation, revealed by epidemiological studies. To understand the beneficial characteristics of ginger, especially its physiological and pharmacological activities at the molecular level, the biological effects of ginger constituents, such as monoterpenes (cineole, citral, limonene and α/β-pinenes), sesquiterpenes (β-elemene, farnesene and zerumbone), phenolics (gingerols, [6]-shogaol, [6]-paradol and zingerone) and diarylheptanoids (curcumin), and the associated signaling pathways are summarized. Ginger constituents are involved in biological activities, such as apoptosis, cell cycle/DNA damage, chromatin/epigenetic regulation, cytoskeletal regulation and adhesion, immunology and inflammation, and neuroscience, and exert their effects through specific signaling pathways associated with cell functions/mechanisms such as autophagy, cellular metabolism, mitogen-activated protein kinase and other signaling, and development/differentiation. Estrogens, such as phytoestrogens, are one of the most important bioactive materials in nature, and the molecular mechanisms of estrogen actions and the assays to detect them have been discussed. The molecular mechanisms of estrogen actions induced by ginger constituents and related applications, such as the chemoprevention of cancers, and the improvement of menopausal syndromes, osteoporosis, endometriosis, prostatic hyperplasia, polycystic ovary syndrome and Alzheimer's disease, were summarized by a comprehensive search of references to understand more about their health benefits and associated health risks.

The Effects of Inhalation Aromatherapy on Postoperative Abdominal Pain: A Three-Arm Randomized Controlled Clinical Trial

PURPOSE

This study compares the effects of inhalation aromatherapy using essential oils of sweet orange and damask rose on postoperative abdominal pain.

DESIGN

A randomized three-arm controlled trial.

METHODS

In this randomized double-blinded, and parallel-group controlled trial, a total of 120 patients who underwent open abdominal surgeries were enrolled using a sequential sampling method. Participants were then randomly assigned to three groups of sweet orange, damask rose, and placebo (distilled water) using the permuted block randomization. When the patients regained full consciousness, a clean gauze impregnated with four drops of either distilled water or essential oils of sweet orange or damask rose were attached to the collar of the patients, and they were asked to inhale the aroma through normal breathing for 30 minutes. Abdominal pain severity was recorded using the visual analog scale at four time points including before the intervention (baseline) and 4, 8, and 12 hours after the intervention.

FINDINGS

Pain reduction after sweet orange inhalation was significantly greater than placebo (at 8 and 12 hours after the intervention) and damask rose (at 12 hours after the intervention). The differences in the mean score of pain severity between all before-and-after observations were statistically significant in the three groups, except in the placebo group between the baseline score of pain severity and the pain severity score at 4 hours after the intervention.

CONCLUSIONS

Inhalation aromatherapy using sweet orange seems to be more effective than the damask rose in reducing pain severity after open abdominal surgeries.

Effect of aromatherapy with Damask rose on alleviating adults' acute pain severity: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND PURPOSE

Although recent studies have investigated the analgesic activity of Damask rose using aromatherapy in different painful conditions, the results are inconclusive. Hence, this systematic review and meta-analysis aimed to clarify the effect of aromatherapy with Damask rose on adults' acute pain.

MATERIAL AND METHODS

The online databases of MEDLINE/PubMed, Scopus, ISI web of science, Embase, ProQuest, CENTRAL, CINAHL, SID, and MagIran were searched up to August 10, 2020. The aim of this study was to find randomized controlled trials on the effect of aromatherapy with Damask rose in any form of administration (inhalation, vapor diffusion, and massage) on different types of acute pain in adults. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. Moreover, the quality of the evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects model was applied to pool data using Stata.

RESULTS

A total of 16 studies met the inclusion criteria, of which only one was not included in the meta-analysis. Pooled analysis revealed that aromatherapy with Damask rose reduced the pain severity significantly (WMD: -2.12; 95% CI [-2.85, -1.40]; P < 0.001). Inhalation aromatherapy (WMD: -2.39; 95% CI [-3.31, -1.48]; P < 0.001) and aromatherapy massage (WMD: -1.16; 95% CI [-1.57, -0.75]; P < 0.001) also had significant effects on pain reduction. The quality of evidence was low.

CONCLUSION

Aromatherapy with Damask rose had a favourable effect on reducing the severity of acute pain in adults. However, there is insufficient evidence for the clinical benefits of aromatherapy with Damask rose due to the low-quality evidence. Accordingly, more high quality randomized clinical trials are needed to make an evidence-based conclusion.