Title : Measuring the effects of aromatherapy on antiemetic use in a total joint Arthroplasty population
Abstract:
BACKGROUND:
Despite significant advances in medical/surgical treatment and anesthesia methods, postoperative nausea and vomiting (PONV) is one of the most common complications of surgical patients. In the orthopedic setting specifically, PONV is one of the most common causes for delayed ambulation and prolonged hospitalization. Antiemetics have long been utilized as standard treatment; however, they come with their own risk of adverse side effects. Aromatherapy has been studied extensively for treatment of nausea; however, evidence for use of aromatherapy in adult orthopedic patients who are experiencing PONV is lacking.
PURPOSE:
To evaluate whether the use of aromatherapy as a complementary intervention for PONV could decrease the number of IV doses of antiemetic given per patient during hospitalization.
METHODS:
A quasi-experiment research design was used on one inpatient unit of an urban orthopedic hospital. One-hundred charts were retrospectively reviewed to establish a control group (n=100). A total of 199 subjects were included in this study. Inclusion criteria for both groups included age 18 or older, primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) performed under spinal anesthesia, and treated with at least once dose of intravenous anti-emetic medication during their hospitalization. For the aromatherapy group, an additional inclusion criteria was agreeing to use aromatherapy for treatment of PONV. Exclusion criteria was any allergy to fragrances in general or declination of offer to participate. Student t-test was used to compare age, Fisher’s Exact Test was used to compare smoking use, Pearson Chi-square Test was used to compare all other categorical variables and linear regression was used for adjusted analysis.
RESULTS:
A total of 199 total hip (57.8%) and knee (42.2%) surgical patients aged 64.8 years (range: 40-82) and majority women (86.4%) were enrolled in the study. Groups were similar in regards to demographics and risk factors. The two groups had no statistically significant difference on ondansetron usage (p=0.38) and metoclopramide usage (p=0.78) between groups, even after adjustment for confounding factors. Patient reported post-aromatherapy nausea level was significantly lower than the baseline nausea level (n=93; p<.001).
CONCLUSION:
Many patients are hesitant to try new medications in the hospital, even if nausea and vomiting is significantly impacting their recovery. However, PONV can lead to delays in ambulation and participation in physical therapy– a key driver in total joint replacement outcomes. In this study, aromatherapy usage did not decrease usage of anti-emetic medication in the orthopedic setting. It is possible that the change in dosage between the two groups was so minute that the sample size was not large enough to detect a significant difference. Despite this, patients did report a statistically significant improvement in their nausea severity after using the aromatherapy pods. Aromatherapy remains a way for patients to self-manage their PONV after orthopedic surgery.
Audience Take Away Notes:
- Understand the incidence of postoperative nausea and vomiting and its impact on surgical outcomes
- Learn about aromatherapy as a complementary intervention for postoperative nausea and vomiting
- Understand the impact of aromatherapy on patient satisfaction
- Gain knowledge regarding the utilization of aromatherapy that could potentially optimize outpatient primary total joint arthroplasty outcomes
