Aromatherapy Versus Acupressure: Impact on Postoperative Pain and Sleep Quality in Pediatric Abdominal Surgery Patients

Abdominal surgery is defined as a broad term used for various surgical procedures around the abdominal region. These can be used to treat or diagnose medical conditions present in that area. The surgery can be performed on multiple sites like the small intestines, spleen, stomach, appendix, and rectum or colon . Abdominal surgery in children can involve various techniques that depend on the organs which require an operation, that divided into two types; laparotomy and laparoscopic surgeries .

Laparotomies are defined as major surgeries which need large incisions on the abdomen of the child. These procedures require close, carful management to avoid it's major complications that extend the time of recovery. On the other hand, laparoscopic surgeries are smaller incisions made significantly than Laparotomies, that make little scars, less blood loss, decreased pain after surgery, and faster recovery . The most common cases of laparotomies among pediatric patients are adhesive bowel obstruction, adhesiolysis, open reduction of intussusception and bowel resection. While the procedures of laparoscopic surgeries that are used in pediatric patients are appendectomy, cholecystectomy, liver biopsy, ovarian distortion and orchidopexy. Pain is the serious postoperative problem that may result from operations due to tissue damage caused by surgical incisions that occurs shortly after surgery. It leads to the production of cellular breakdown and inflammatory mediators which trigger the nerve ending and send messages through the dorsal horn to the brain. The end effect of this pain transmission neuronal activity is pain perception. More than 80% of children who undergo surgical procedures experience acute postoperative pain. About 30-43% of pediatric patients report moderate or severe pain on the first postoperative day . The next most prevalent post-operative problem is insomnia. Hospitalized children frequently experience sleep disorders for many reasons such as physical condition, medications, fear of death, light, environmental noise, unpleasant odors, foreign instruments, nursing interventions, invasive procedures, complications of disease, loss of privacy and staying away from family. About 40-60% of hospitalized children have sleep disturbance . The hospitalized children stay awake for a significant amount of time; they cannot benefit from the therapeutic effects of sleep. Inadequate and unsatisfactory sleep impedes healing process by having negative effects on the immune system, wound healing process, cause fatigue, anorexia, muscle atrophy, delayed recovery, affect cognitive functions of children and increasing their level of stress and anxiety as well as, impair children's mental and physical development by directly affecting protein synthesis, cell differentiation, and growth hormone secretion .

Postoperative pain and insomnia are associated with increased morbidity and dysfunction that can delay time to ambulation and prolong the hospital length of stay. When postsurgical pain and insomnia are not appropriately managed, they may develop into chronic postoperative pain and fatigue, which, in turn, may lead to dysfunction, disability, and depression, and be difficult to manage.

Pediatric nurses play an important role in managing postoperative pain and insomnia among pediatric patients. They spend most of their time with the child and are accountable for assessment, the administration of analgesics, monitoring and reporting the outcomes of the given treatments. Some nurses believe that pain and insomnia are expected outcomes of surgery, hence, there is no need to alleviate the postoperative pain and insomnia completely .

The use of Complementary Alternative Medicine (CAM) in pediatric populations is considerably increased, especially for pain, sleep disturbance and acute conditions. The main reasons for seeking CAM were: the wish of avoiding chronic use of drugs with their related side effects, the desire of an integrated approach, the reported inefficacy of conventional medicine, and a more suitable children disposition to CAM than to pharmacological compound .

Aromatherapy is considering one type of CAM. Aromatherapy refers to the therapeutic use of essential oils absorbed through the skin or olfactory system. It's used for controlling the pain, anxiety, depression, stress, and improves the sleep pattern among pediatric patients. The benefits of lavender's aromatherapy that linalool and linalyl acetate present in this plant can stimulate parasympathetic system. In addition, linalyl acetate has narcotic effects and linalool acts as a sedative. This herb improves the heart function and as a circulatory stimulant, it has beneficial effects on coronary blood flow.

Another type of CAM is acupressure, it's a non-invasive form of traditional Chinese Medicine that is common throughout Chinese society as a method of promoting health. It includes applying of pressure manually to certain points on the body through energy pathways called meridians which spread energy in the body and connect the body parts with its organs. Appling acupressure technique can be done by using the fingertips or wristband to relieve post-operative pain and improve quality of sleep . Pain and sleep disorders are treated using both pharmacological and non-pharmacological methods. Sedative-hypnotic agents used in pharmacological treatments can reduce pain and increase the quality of sleep significantly; however, it is stated that these drugs have side effects, cause addiction and do not provide adequate sleep . Therefore, it is essential to employ and implement non-pharmacological methods that are safer and have fewer side effects than the pharmacological methods.

Inclusion criteria

Children age 6 to 12 years of both sexes. Conscious and having a caretaker. No history of respiratory diseases or has problems with his sense of smell (for aromatherapy group).

Children undergoing abdominal surgeries such as acute appendicitis, intestinal obstruction, Inguinal and umbilical hernia

Exclusion criteria

Post-operative severe pain preventing children from participating in the study. Children who have chronic disease such as cardiac and renal disease. The existence of coagulation disorders, as well as skin diseases or skin burns in the pressure points where in acupressure could be applied (for acupressure group).