The effect of lavender oil inhalation on pain, anxiety, and sleep quality after coronary artery bypass graft: a randomized controlled trial protocol

Yeşim Dikmen Aydin, Aysel Gurkan


Background: Pain, anxiety, and sleep disorders are common side effects of coronary artery bypass graft (CABG) surgery. Although pharmacological agents are currently used in the treatment of these problems, in addition to their undesirable side effects, they increase healthcare costs, and their inadequate control leads to morbidities, prolonged hospital stay and increased burden of care. Therefore, supportive interventions are needed. The aim of this study is to determine the effect of lavender oil inhalation on the pain intensity, anxiety and sleep quality of patients that underwent CABG surgery.

Methods: This study was planned as a prospective randomized controlled trial. Participants meeting the inclusion criteria will be randomly assigned to the intervention and control groups. During the hospitalization period after CABG surgery, 2% lavender oil (Lavandula angustifolia) inhalation will be applied to the intervention group three times a day, while the control group will only receive routine care. The pain intensity of the groups will be evaluated with the numeric rating scale, anxiety levels with the state-trait anxiety inventory, and sleep quality with the Richards-Campbell sleep questionnaire.

Conclusions: There is a need for new approaches to improve the physiological and psychological health of patients after CABG surgery and help them return to their daily life activities and social lives in a shorter time. This trial will allow for the assessment of the effects of this intervention and provide valuable evidence to guide clinical practice.

Trial registration: This trial was registered in May, 2022 (NCT05377983).


CABG surgery, Lavender oil, Pain, Anxiety, Sleep

Full Text:



Avcı IS. Koroner arter hastalıkları cerrahisi ve hemşirelik bakımı. J Surg-Nurs-Special Top. 2018;4(1):8-19.

Türkiye İstatistik Kurumu. Ölüm nedeni istatistikleri 2018. Available at Index?p=Olum-Nedeni-Istatistikleri-2018-30626. Accessed 28 March 2021.

Gorji MA, Ashrastaghi OG, Habibi V, Charati JY, Ebrahimzadeh MA, Ayasi, M. The effectiveness of lavender essence on sternotomy related pain intensity after coronary artery bypass grafting. Adv Biomed Res. 2015;1-6.

Seyhan Ak E, Ayoğlu T, Kandemir D. Kalp cerrahisi sonrası ağrı kontrolünde yeni yaklaşımlar. İKÇÜSBFD. 2017;2(1):29-32.

Lafçı G, Çağlı K, Özcan F. Koroner arter baypas greft cerrahisi: Güncelleme. Turk Gogus Kalp Dama. 2014;22(1):211-5.

Abadi SEH, Paryad E, Khanghah AG, Pasdaran A, Leyli EK, Meibodi AM. Effects of aromatherapy using lavender oil on hemodynamic ındices after coronary artery bypass graft surgery. J Holist Nurs Midwifery. 2018;28(3):163-70.

Akıncı B, Yeldan İ, Bayramoğlu Z, Akpınar TB. The effects of posture and relaxation training on sleep, dyspnea, painand, quality of life in the short-term after cardiac surgery: a pilot study. Turk Gogus Kalp Dama. 2016;24(2):258-65.

Doering LV, Chen B, McGuire A, Bodán RC, Irwin, MR. Persistent depressive symptoms and pain after cardiac surgery. Psychosom Med. 2014;76(6):437-44.

Liao WC, Huang CY, Huang TY, Hwang SL. A systematic review of sleep patterns and factors that disturb sleep after heart surgery. J Nurs Res. 2011;19(4):275-88.

Yang PL, Huang GS, Tsai CS, Lou MF. Sleep quality and emotional correlates in Taiwanese coronary artery bypass graft patients 1 week and 1 month after hospital discharge: A repeated descriptive correlational study. PloS One. 2015;10(8):e0136431.

Bang YY, Park H. Effects of auricular acupressure on the quality of sleep and anxiety in patients undergoing cardiac surgery: a single-blind, randomized controlled trial. Appl Nurs Res. 2020;53;1-8.

Kaynar AŞ, Şimşek T, Alpar ŞE. Açık kalp ameliyatlarında preoperatif eğitimin: Postoperatif dönemde anksiyete ve iyileşme süreci üzerine etkisinin incelenmesi. EGEHFD. 2018;34(3):45-62.

Sidar A, Dedeli O, İşkesen Aİ. Açık kalp cerrahisi öncesi ve sonrası hastaların kaygı ve ağrı distresi: ağrı düzeyi ile ilişkisinin incelenmesi. Yoğun Bakım Derg. 2013;4:1-8.

Morone NE, Weiner DK, Belnap BH, Hum DB, Karp JF, Mazumdar S et al. The ımpact of pain and depression on post-cabg recovery. Psychosom Med. 2010;72(7):620-25.

Chouchou F, Khoury S, Chauny JM, Denis R, Lavigne GJ. Postoperative sleep disruptions: a potential catalyst of acute pain? Sleep Med Rev. 2014;18(3):273-82.

Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007;3(01):33-6.

Karadag E, Samancioglu S, Özden D, Bakir E. Effects of aromatherapy on sleep quality and anxiety of patients. British Association of Critical Care Nurses. 2015;22(2):105-12.

Darzi HB, Azimi AV, Ghasemi S, Ebadi A, Salthyapalan T, Sahebkar A. The effect of aromatherapy with rose and lavender on anxiety, surgical site pain, and extubation time after open-heart surgery: a double-center randomized controlled trial. Phytother Res. 2020;1-10.

Salamati A, Mashouf S, Sahbaei F, Mojab F. Effects of ınhalation of lavender essential oil on open-heart surgery pain. Iran J Pharm Res. 2014;13(4):1257-61.

Abdou F, Abd El-Hafez AI. Effect of foot reflexology practice on acute pain and anxiety of critically ill patients after cardiothoracic surgery. IJIRMS. 2018;3(08):2121-8.

Totonchi Z, Seifi S, Chitsazan M, Ghavidel AA, Baazm F, Faritus SZ. Pain location and intensity during the first week following coronary artery bypass graft surgery. Anesth Pain Med. 2014;4(1):1-7.

Mazzeffi M, Khelemsky Y. Poststernotomy pain: a clinical review. J Cardiothorac Vasc Anesth. 2011;25(6):1163-78.

Taherian T, Shorofi SA, Zeydi AE, Charati JY, Pouresmail Z, Jafari H. The effects of Hegu point ice massage on post-sternotomy pain in patients undergoing coronary artery bypass grafting: a single–blind, randomized, clinical trial. Adv Integr Med. 2020;7(2):73-8.

Nguyen Q, Uminski K, Hiebert BM, Tangri N, Arora RC. Midterm outcomes after postoperative delirium on cognition and mood in patients after cardiac surgery. J Thorac Cardiovasc Surg. 2018;155(2):660-7.

Kang HJ, Nam ES, Lee Y, Kim M. How strong is the evidence for the anxiolytic efficacy of lavender? systematic review and meta-analysis of randomized controlled trials. Asian Nurs Res. 2019;1-11.

Fazlollahpour-Rokni F, Shorofi SA, Mousavinasab N, Ghafari R, Esmaeili R. The effect of inhalation aromatherapy with rose essential oil on the anxiety of patients undergoing coronary artery bypass graft surgery. Complement Ther Clin Pract. 2019;34:201-7.

Bagheri H, Salmani T, Nourian J, Mirrezaie SM, AbbasiA, Mardani A, et al. The effects of ınhalation aromatherapy using lavender essential oil on postoperative pain of ınguinal hernia: a randomized controlled trial. J PeriAnesth Nurs. 2020;1-7.

Soltanpour A, Alijanihab F, Naserib M, Kazemnejadc A, Heidarid MR. Effects of melissa officinalis on anxiety and sleep quality in patients undergoing coronary artery bypass surgery: a double-blind randomized placebo-controlled trial. Eur J Integr Med. 2019;28:27-32.

Abbaszadeh R, Tabari F, Taherian K, Sedigheh T. Lavender aromatherapy in pain management: a review study. Pharmacophore. 2017;8(3):50-4.

Donellia D, Antonellia M, Bellinazzi C, Gensinic GF, Firenzuoli F. Effects of lavender on anxiety: a systematic review and meta-analysis. Phytomedicine. 2019;65:1-31.

Perry R, Terry R, Watson LK, Ernst E. Is lavender an anxiolytic drug? A systematic review of randomised clinical trials. Phytomedicine. 2012;19:825-35.

Lakhan SE, Sheafer H, Tepper D. The effectiveness of aromatherapy in reducing pain: a systematic review and meta-analysis. Pain Res Treat. 2016;13.

Abdelhakim AM, Hussein AS, Doheim MF, Sayed AK. The effect of inhalation aromatherapy in patients undergoing cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2020;48:1-8.

Fismer KL, Pilkington K. Lavender and sleep: a systematic review of the evidence. Eur J Integr Med. 2012:e436-e447.

Seifi Z, Bikmoradi A, Bazrafshan MR, Poorolajal J, Araghchian M, Kashfi SH, et al. The effect of inhalation aromatherapy with lavender essential oil on pain severity of patients after coronary artery bypass surgery: a single-blind randomised clinical trial. J Clin Diagn Res. 2018;12(7):1-5.

Hasanzadeh F, Kashouk NM, Amini S, Asili J, Emami SA, Vashani HB, et al. The effect of cold application and lavender oil inhalation in cardiac surgery patients undergoing chest tube removal. EXCLI J. 2016;15:64-74.

Hosseini S, Heydari A, Vakili MA, Moghadam S, Tazyky SA. Effect of lavender essence inhalation on the level of anxiety and blood cortisol in candidates for open-heart surgery. Iran J Nurs Midwifery Res. 2016;21(4):397-401.

Cho MY, Min ES, Hur MH, Le MS. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units. Evid Based Complement Alternat Med. 2013;1-6.

Lytle J, Mwatha C, Davis KK. Effect of lavender aromatherapy on vıtal sıgns and perceıved qualıty of sleep ın the ıntermedıate care unıt: a pılot study. Am J Crıt Care. 2014;23(1):24-9.

Cho EH, Lee MY, Hur MH. The effects of aromatherapy on intensive care unit patients’ stress and sleep quality: a nonrandomised controlled trial. Evid Based Complement Alternat Med. 2017;1-10.

Babar A, Al-Wabel NA, Shams S, Ahamad A, Khan SA, Anwar F. Essential oils used in aromatherapy: a systemic review. Asian Pac J Trop Biomed. 2015;5(8):601-11.

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200-7.

Kutlubay Z, Pehlivan Ö, Engin B, Serdaroğlu S. Allerji deri testi. Dermatoz. 2012;3(3):102-7.

Öner N, Le Compte A. Durumluk-sürekli kaygı envanteri. İçinde: Öner N (eds.). Türkiye’de Kullanılan Psikolojik Testler Bir Başvuru Kaynağı. 3. Basım, İstanbul, Boğaziçi Üniversitesi Yayınları. 1997; 365-73.

Özlü ZK, Özer N. Richard-Campbell Uyku Ölçeği geçerlilik ve güvenilirlik çalışması. J Turk Sleep Med. 2015;2:29-32.

Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Guidelines on the management of postoperative pain. J Pain. 2016;17(2):131-57.

Van Dijk JF, van Wick AJ, Kappen TH, Peelen LM, Kalkman CJ, Schuurmans MJ. Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: a cross-sectional study. Int J Nurs Stud. 2012;49:65-71.

Gurkan A, Aldemir K, Andsoy II, Gül A. Ameliyat sonrası akut ağrı yoğunluğunun değerlendirilmesinde dört farklı ağrı ölçeğinin karşılaştırılması. Cukurova Med J. 2020;45(4):1562-71.

van Dijk JF, Kappen TH, van Wijk AJ, Kalkman CJ, Schuurmans MJ. The diagnostic value of the numeric pain rating scale in older postoperative patients. J Clin Nurs. 2012; 3018-24.