Effect of Lavender Aromatherapy on Preoperative Anxiety, Stress, and Depression in Orthopedic Surgery Patients

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.

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).