Effect of Aromatherapy on Perioperative Anxiety Level in Cesarean Sections

April 15, 2022 updated by: Feyza Calisir, Kahramanmaras Sutcu Imam University

Aromaterapinin Spinal Anestezi Uygulanan Sezaryen Vakalarında Perioperatif Anksiyete Düzeyine Etkisi / The Effect Of Aromatherapy On The Level Of Intraoperative Anxiety In Caesarean Case Under Spinal Anesthesia

Spinal anesthesia has been accepted as the first choice for elective cesarean section due to its easy application technique and elimination of the risks of difficult intubation and aspiration. Neuraxial anesthesia is considered superior to general anesthesia in terms of fetal well-being. The state of having an operation and not being aware of the operation by the patient can cause serious anxiety and fear in the patient. Fear of surgical failure, not fully understanding the anesthesia method, possible risks of anesthesia and expected pain during the postoperative recovery period contribute to the patient's anxiety. Considering the patients undergoing elective surgery under spinal anesthesia, there is a moderate level of anxiety associated with advanced age and female gender. Reducing the stress and anxiety in the patient during elective surgery will reduce the neurohormonal response to surgery and reduce complications. Early skin-to-skin contact with the mother provides many benefits to the newborn, but maternal sedation in the operating room during cesarean delivery should also be within safe limits to avoid early skin-to-skin contact. Aromatherapy relies on the use of essential oils to contribute to physical and psychological well-being. The oils can be massaged into the skin, or inhaled using a steam infusion or burner. Birth pain is a severe pain, and the feeling of pain may increase with tension, fear and anxiety during delivery. Apart from medical methods, many complementary treatments such as acupuncture, reflexology, homeopathy, hypnotherapy, music and aromatherapy are tried to reduce pain and anxiety. Lavender aromatherapy has been shown to significantly reduce anxiety or pain in various surgical procedures. There is a growing literature on the use of lavender aromatherapy as an anxiolytic agent. Based on these findings, the study aimed to contribute to early mother-to-baby contact and breast milk intake by reducing perioperative maternal anxiety and therefore the use of sedative drugs during cesarean section performed under spinal anesthesia with the intraoperative use of lavender aromatherapy. This is the first study to evaluate the effect of aromatherapy on anxiety in cases of cesarean section under anesthesia.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Patients who were to undergo lavender aromatherapy with an oxygen mask after the birth of the baby were randomly divided into two groups: aromatherapy (A) (n=48) and control (C) (n=48), who inhaled odorless essential oil. Participants were admitted to the preoperative preparation room 20 min before the operation, and their age, height, weight, and ASA risk scores were recorded after their informed consent was obtained. They were monitored and sent to the operating room after their baseline anxiety levels were measured and recorded using the Visual Analog Scale (VAS) for pain and State-Trait Anxiety Inventory (STAI-I). Following local sterilization with the patient in the sitting position, the lumbar (L) region was punctured at the L3-L4 level or the L4-L5 level with a 25-G, 90 mm pencil-point spinal atraumatic needle. After visualization of the cerebral spinal fluid flow, 10 mg of 0.5% bupivacaine (Marcaine® Spinal Heavy 0.5% ampule, AstraZeneca, UK) was administered for spinal anesthesia. Then, after the birth of the baby, two drops of 100% pure medical lavender oil (Lavandula angustifolia) and two drops of odorless baby oil (jojoba and almond oil) was inhaled for 5 min through an oxygen mask by groups A and C, respectively. After 5 min, 2 mg intravenous midazolam for sedation was administred to the patients who gained 1 point from the Ramsey Sedation Scale (RSS). Complications, such as nausea, vomiting, hypotension (mean arterial pressure<60 mmHg), and allergies that developed after aromatherapy, were recorded. At the end of the operation, the dose added to the initial midazolam dose for all patients and the total surgical time were recorded. VAS pain and STAI-I scores were re-evaluated at the third postoperative hour, and the satisfaction levels of each patient after aromatherapy were recorded according to the Likert scale as "very satisfied, satisfied, moderate, and not at all satisfied".

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
96

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey
      • Kahramanmaraş, Turkey, 46100
        • KahramanmarasSIU

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Pregnant women who underwent CS with spinal anesthesia
  • Ninety-six patients aged between 18 and 45 years,
  • With a height of ≥156 centimeters (cm)
  • Gestational age of >37 weeks
  • The American Society of Anesthesiologists (ASA) II risk group, who were scheduled for elective CS under spinal anesthesia

Exclusion Criteria:

-

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: the aromatherapy group
After the birth of the baby, two drops of 100% pure medical lavender oil (Lavandula angustifolia) was inhaled for 5 min through an oxygen mask by groups A and C, respectively. After 5 min, 2 mg intravenous midazolam for sedation was administred to the patients who gained 1 point from the Ramsey Sedation Scale (RSS). Complications, such as nausea, vomiting, hypotension (mean arterial pressure<60 mmHg), and allergies that developed after aromatherapy, were recorded. At the end of the operation, the dose added to the initial midazolam dose for all patients and the total surgical time were recorded. VAS pain and STAI-I scores were re-evaluated at the third postoperative hour, and the satisfaction levels of each patient after aromatherapy were recorded according to the Likert scale as "very satisfied, satisfied, moderate, and not at all satisfied".
Other: Aromatherapy
Ninety-six patients aged between 18 and 45 years, with a height of ≥156 centimeters (cm), and a gestational age of >37 weeks, in the ASA II risk group, who were scheduled for elective CS under spinal anesthesia, were included in the study. Patients who were to undergo lavender aromatherapy with an oxygen mask after the birth of the baby were randomly divided into two groups: aromatherapy (A) (n=48) and control (C) (n=48), who inhaled odorless essential oil. Participants were admitted to the preoperative preparation room 20 min before the operation, and their age, height, weight, and ASA risk scores were recorded after their informed consent was obtained. They were monitored and sent to the operating room after their baseline anxiety levels were measured and recorded using the Visual Analog Scale (VAS) for pain and State-Trait Anxiety Inventory (STAI-I).
Placebo Comparator: the control group
Then, after the birth of the baby two drops of odorless baby oil (jojoba and almond oil) was inhaled for 5 min through an oxygen mask by groups A and C, respectively. After 5 min, 2 mg intravenous midazolam for sedation was administred to the patients who gained 1 point from the Ramsey Sedation Scale (RSS). Complications, such as nausea, vomiting, hypotension (mean arterial pressure<60 mmHg), and allergies that developed after aromatherapy, were recorded. At the end of the operation, the dose added to the initial midazolam dose for all patients and the total surgical time were recorded. VAS pain and STAI-I scores were re-evaluated at the third postoperative hour, and the satisfaction levels of each patient after aromatherapy were recorded according to the Likert scale as "very satisfied, satisfied, moderate, and not at all satisfied".
Other: Placebo oil (odorless baby oil- jojoba and almond oil)
Ninety-six patients aged between 18 and 45 years, with a height of ≥156 centimeters (cm), and a gestational age of >37 weeks, in the ASA II risk group, who were scheduled for elective CS under spinal anesthesia, were included in the study. Patients who were to undergo lavender aromatherapy with an oxygen mask after the birth of the baby were randomly divided into two groups: aromatherapy (A) (n=48) and control (C) (n=48), who inhaled odorless essential oil. Participants were admitted to the preoperative preparation room 20 min before the operation, and their age, height, weight, and ASA risk scores were recorded after their informed consent was obtained. They were monitored and sent to the operating room after their baseline anxiety levels were measured and recorded using the Visual Analog Scale (VAS) for pain and State-Trait Anxiety Inventory (STAI-I).

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Comparison between patients using aromatherapy and those without aromatherapy
Time Frame: Within one hour following the cesarean section
A comparison will be made between the two groups, one group using lavender aromatherapy and one group without aromatherapy. T-tests used to assess whether the two groups are statistically different from each other. Comparisons made by comparing with the midazolam consumption. After 5 minutes from baby's birth, 2 mg intravenous midazolam for sedation was administred to the patients who gained 1 point from the Ramsey Sedation Scale. It is a six category scale that allows the evaluation of the sedation level and was created by Ramsey et al. (score 1: anxious, agitated and restless; score 2: cooperative, oriented and tranquil; score 3: responsive to commands only; score 4: brisk response to a light glabellar tap; score 5: sluggish response to a light glabellar tap or loud auditory stimulus; score 6: means no response).
Within one hour following the cesarean section
Comparison between patients using aromatherapy and those without aromatherapy
Time Frame: Postoperative 3rd hour
Comparison between two groups for the postoperative 3rd hour STAI-I scores. Ensuring the baby's clean breast milk intake and early mother-infant skin contact
Postoperative 3rd hour

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Kahramanmaras Sutcu Imam University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 1, 2020

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2021

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 1, 2021

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
March 28, 2022

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 15, 2022

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
April 19, 2022

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
April 19, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 15, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
April 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2020/05-14

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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