Effect of Lavender Aromatherapy on Preoperative Anxiety, Stress, and Depression in Orthopedic Surgery Patients (LAV-ORTHO)

Effect of Aromatherapy With Lavender Essential Oil on Preoperative Anxiety, Stress, and Depression Among Patients Undergoing Orthopedic Surgeries: A Quasi-Experimental Study

This study evaluates whether inhalation aromatherapy with lavender essential oil can reduce anxiety, stress, and depression in adult patients before orthopedic surgery in Jordan. Orthopedic procedures are often associated with high levels of psychological distress, which may worsen pain, delay recovery, and prolong hospital stay. Aromatherapy is a simple, non-drug intervention that may help patients feel calmer and better prepared for surgery.

The study was conducted in two large public hospitals, Al-Bashir Hospital in Amman and Al Hussein Al-Salt New Hospital in Al-Salt. Adult patients (18 years or older) scheduled for major orthopedic operations who could read and write Arabic and agreed to participate were invited to join the study. Patients with respiratory problems, an allergy to lavender oil, pregnancy, or severe non-orthopedic pain were excluded.

Participants were assigned to one of two groups. In the intervention group, patients inhaled 100% lavender essential oil for 20 minutes from a cotton pad placed about 5 cm from the nose before surgery. In the control group, patients inhaled room air only and received routine preoperative nursing care. All participants completed a short questionnaire, the 21-item Depression Anxiety Stress Scale-21 (DASS-21), before and after the intervention to measure their levels of anxiety, stress, and depression.

A total of 128 patients took part, with 64 in the lavender group and 64 in the control group. The results showed that patients who received lavender aromatherapy had lower anxiety, stress, and depression scores before surgery compared with those who did not receive aromatherapy. These findings suggest that lavender inhalation aromatherapy may be a safe, low-cost, and easy-to-use option to improve psychological well-being for orthopedic surgery patients in the preoperative period.

Study Overview

• Status: Completed
• Conditions: Depressive Symptoms; Preoperative Anxiety; Psychological Stress; Orthopedic Surgery Patients
• Intervention / Treatment: Other: Lavender Essential Oil Inhalation

Detailed Description

This quasi-experimental study was designed to determine the effect of inhalation aromatherapy with lavender essential oil on preoperative anxiety, stress, and depression among patients undergoing orthopedic surgeries in Jordan. Orthopedic operations are among the most painful surgical procedures and are frequently associated with high levels of psychological distress, which can negatively affect postoperative outcomes, length of hospital stay, and patient satisfaction. Non-pharmacological interventions such as aromatherapy have been proposed as simple, low-cost strategies to improve patients' psychological well-being before surgery.

The study was conducted in two large governmental referral hospitals, Al-Bashir Hospital in Amman and Al Hussein Al-Salt New Hospital in Al-Salt, both of which have high volumes of orthopedic surgeries. A convenience sample of adult patients (≥18 years) scheduled for major orthopedic procedures (including total knee replacement [TKR], total hip replacement [THR], and fracture fixation) was recruited based on predefined inclusion and exclusion criteria. Inclusion criteria required the ability to read and write Arabic, absence of apparent cognitive impairment, and willingness to participate, while patients with respiratory problems, allergy to lavender oil, pregnancy, or severe non-orthopedic pain were excluded.

Participants were allocated into two non-randomized groups: an intervention group and a control group. The intervention group received lavender inhalation aromatherapy by breathing in 100% lavender essential oil, applied as 2 drops on a cotton pad placed approximately 5 cm from the nose, for 20 minutes during the preoperative period. The control group inhaled room air only and received routine preoperative nursing care without any aromatherapy. Both groups completed the Depression Anxiety Stress Scale-21 (DASS-21), a validated 21-item self-report instrument that measures the severity of anxiety, stress, and depression symptoms, before and after the intervention.

A total of 128 patients participated in the study, with 64 patients in the intervention group and 64 in the control group. Data were collected using structured questionnaires and analyzed using IBM Statistical Package for the Social Sciences (SPSS) software, version 26. Appropriate descriptive and inferential statistics, including independent t-tests, were used to compare pre- and post-intervention scores within and between groups. The main outcome measures were changes in DASS-21 anxiety, stress, and depression subscale scores from pre- to post-intervention.

The findings indicated that lavender inhalation aromatherapy led to significant reductions in preoperative anxiety, stress, and depression scores in the intervention group compared with the control group, which did not receive aromatherapy. These results support the use of lavender aromatherapy as a complementary, non-pharmacological nursing intervention that is easy to administer, cost-effective, and well tolerated by patients undergoing orthopedic surgery. The study suggests that integrating aromatherapy into routine preoperative care may contribute to better psychological outcomes and potentially improve overall surgical recovery in this population.

• Study Type: Interventional
• Enrollment (Actual): 128
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Jordan
  • Amman, Jordan, 11623
    • Al-Bashir Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Adults aged 18 years or older.

Undergoing major orthopedic surgeries (e.g., total knee replacement, total hip replacement, fracture reduction and fixation).

Able to read and write in Arabic.

Male or female patients.

No apparent cognitive deficit.

Willing to participate and able to provide written informed consent.

Exclusion Criteria:

Younger than 18 years of age.

Unable to read or write Arabic.

Mentally unqualified or with obvious cognitive impairment.

History of respiratory problems (e.g., asthma, chronic obstructive pulmonary disease) that may be affected by inhalation of essential oils.

Known allergy or hypersensitivity to lavender essential oil.

Pregnant women.

Suffering from severe pain not related to the orthopedic surgery (e.g., burn pain).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lavender Aromatherapy; Patients in this arm receive inhalation aromatherapy with 100% lavender essential oil in addition to routine preoperative nursing care before orthopedic surgery.	Other: Lavender Essential Oil Inhalation; Patients inhale 100% lavender essential oil applied as two drops on a cotton pad placed approximately 5 cm from the nose for 20 minutes during the preoperative period, in addition to routine preoperative nursing care.
No Intervention: Control - Room Air; Patients inhale room air only and receive routine preoperative nursing care, with no aromatherapy administered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Preoperative Anxiety Score (DASS-21)	Change in preoperative anxiety score, measured using the Depression Anxiety Stress Scale-21 (DASS-21). The DASS-21 anxiety subscale ranges from 0 to 21, with higher scores indicating more severe anxiety and lower scores indicating better psychological status. The outcome is defined as the change in the anxiety subscale score from pre-intervention (baseline) to post-intervention in patients undergoing orthopedic surgery.	From baseline (within 2 hours before intervention) to immediately after the 20-minute inhalation session on the day of surgery.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Preoperative Depression Score (DASS-21)	Change in preoperative depression score, measured using the Depression Anxiety Stress Scale-21 (DASS-21). The DASS-21 depression subscale ranges from 0 to 21, with higher scores indicating more severe depressive symptoms and lower scores indicating better psychological status. The outcome is defined as the change in the depression subscale score from pre-intervention (baseline) to post-intervention, comparing the lavender aromatherapy group with the control group in patients undergoing orthopedic surgery.	The data were collected from baseline (within 2 hours before intervention) to immediately after the 20-minute inhalation session on the day of surgery.

Collaborators and Investigators

• Sponsor: Al-Zaytoonah University of Jordan
• Investigators: Study Director: Andaleeb Abu Kamel, PDH, Faculty of Nursing, Al-Zaytoonah University of Jordan

Publications and helpful links

General Publications

• Al-Zaytoonah University of Jordan: https://www.zuj.edu.jo

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2024
• Primary Completion (Actual): April 30, 2024
• Study Completion (Actual): April 30, 2024

Study Registration Dates

• First Submitted: March 31, 2026
• First Submitted That Met QC Criteria: March 31, 2026
• First Posted (Actual): April 7, 2026

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 6, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Depression; Anxiety; Stress; Aromatherapy; Orthopedic Surgery; Non-pharmacological Intervention
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Behavior; Anxiety Disorders; Depression; Stress, Psychological
• Other Study ID Numbers: AZUJ-NUR-AROMA-ORTHO-2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because this is a single-center academic master's thesis with limited resources and no plan or infrastructure for external data sharing.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No