Inhaled Lavender Aromatherapy for Preoperative Anxiety: A Systematic Review of Randomized Controlled Trials
DOI:
https://doi.org/10.33755/jkk.v12i2.1008Keywords:
inhalation, lavender aromatherapy, Complementary therapy, preoperative anxiety, randomized controlled trials, surgeryAbstract
Background: Preoperative anxiety is common among patients undergoing surgery and may adversely affect perioperative outcomes, including hemodynamic instability, increased anesthetic requirements, and delayed recovery. Lavender aromatherapy has been widely used as a complementary non-pharmacological intervention; however, its effectiveness in preoperative care remains variably reported across studies.
Objective: This review aimed to synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of inhaled lavender aromatherapy in reducing preoperative anxiety among adult surgical patients.
Methods: A structured review of RCTs was conducted using Scopus, PubMed, and ScienceDirect. Studies published within the last 10 years were searched using combinations of terms related to lavender aromatherapy, inhalation, and preoperative anxiety. Eligibility criteria were defined using the PICOS framework. After duplicate removal, title and abstract screening, and full-text assessment, 11 RCTs were included in the final qualitative synthesis. Due to heterogeneity in surgical populations, intervention protocols, comparators, and anxiety measurement tools, findings were synthesized narratively.
Results: Eleven RCTs met the inclusion criteria. Most studies reported reductions in preoperative anxiety following inhaled lavender aromatherapy compared with standard care, no-aroma control, or placebo. Several trials also reported additional benefits, such as improved hemodynamic parameters, reduced cortisol levels, and lower anesthetic requirements. However, the findings were not entirely consistent, as some studies found lavender to be comparable to other non-pharmacological interventions or not significantly different from placebo.
Conclusion: Inhaled lavender aromatherapy appears to be a promising complementary intervention for reducing preoperative anxiety in adult surgical patients. Nevertheless, the evidence remains heterogeneous, and effectiveness may vary according to clinical context, comparator type, and intervention protocol. Further high-quality trials using standardized administration methods and outcome measures are needed to clarify its clinical role.
References
1. Shirzad M, Nasiri E, Hesamirostami M, Akbari H. The effect of lavender on anxiety and hemodynamic status before septorhinoplasy and rhinoplasty. J PeriAnesthesia Nurs [Internet]. 2023;38(1):45–50. Available from: https://doi.org/10.1016/j.jopan.2022.05.067
2. Moradifar N, Amraei M, Karami K, Shahijan MK, Nadri S, Amin A. Aromatherapy with lavender essential oil in patients with surgery-related anxiety: A systematic review. J Pharmacogn. 2021;8(4):101–11.
3. Kulakaç N, Sayılan AA. Effect of lavender oil on preoperative anxiety systematic review and meta-analysis. J PeriAnesthesia Nurs [Internet]. 2024;39(2):218–25. Available from: https://doi.org/10.1016/j.jopan.2023.07.016
4. Cevik B. The evaluation of anxiety levels and determinant factors in preoperative patients. Int J Med Res Heal Sci. 2018;7(1):135–43.
5. Anisah IN, Maliya A. Efektivitas relaksasi benson terhadap kecemasan pasien yang menjalani hemodialisa. J Ber Ilmu Keperawatan. 2021;14(1):57–64.
6. Wotman M, Levinger J, Leung L, Kallush A, Mauer E, Kacker A. The efficacy of lavender aromatherapy in reducing preoperative anxiety in ambulatory surgery patients undergoing procedures in general otolaryngology. Laryngoscope Investig Otolaryngol. 2017;(December):437–41.
7. Çalışır F, Urfalıoğlu A, Bilal B, Tok A, Bolcal HA, Öksüz H. The effect of lavender aromatherapy on the level of intraoperative anxiety in caesarean case under spinal anesthesia: A randomized controlled trial. Explore [Internet]. 2023;19(3):356–61. Available from: https://pubmed.ncbi.nlm.nih.gov/36476355/
8. Widyasari ANF, Azizah LWN, Maliya A, Kurniasari D. Terapi benson dan aromaterapi lavender untuk mengurangi kecemasan pada pasien hemodialisa: Literatur review. J Ners. 2025;9(1):267–73.
9. Farrar AJ, Farrar FC. Clinical aromatherapy. Nurs Clin NA [Internet]. 2020;55(4):489–504. Available from: https://doi.org/10.1016/j.cnur.2020.06.015
10. Saylam B, Efesoy O, Akbay E, Erdem E. The effect of inhaler aromatherapy on pain and anxiety in patients undergoing shock wave lithotripsy. Duzce Med J. 2021;23(3):318–22.
11. Kamilatunnuha FR, Dewi E, Nurhayati FD. Perawatan pasien dengan aromaterapi lavender sebagai upaya pendukung untuk memperbaiki kualitas tidur dan tanda-tanda vital serta menurunkan skala stres. J Ners [Internet]. 2025;9(2):2947–52. Available from: https://doi.org/10.31004/jn.v9i2.44366
12. Bagheri H, Salmani T, Nourian J, Mirrezaie SM, Abbasi A, Mardani A, et al. The effects of inhalation aromatherapy using lavender essential oil on postoperative pain of inguinal hernia: A randomized controlled trial. J Perianesthesia Nurs [Internet]. 2020;35(6):642–8. Available from: https://doi.org/10.1016/j.jopan.2020.03.003
13. Pourmohammad R, Nasiri-Formi E, Parvizi A, Bidgol AS, Haddadi S, Akbari H. Comparative effects of lavender aromatherapy and nature sounds on anxiety and pain in cataract surgery patients: A randomized controlled trial. J Integr Complement Med. 2025;00(00):1–8.
14. Stanley PF, Wan LF, Karim RA. A randomized prospective placebo-controlled study of the effects of lavender aromatherapy on preoperative anxiety in cataract surgery patients. J PeriAnesthesia Nurs [Internet]. 2019;35(4):403–6. Available from: https://doi.org/10.1016/j.jopan.2019.12.004
15. Rahman RA, Dewan MMV, Masri SNNS, Mokhtar MN, Abdullah FH, Nor N. Lavender aromatherapy: Its effect on preoperative anxiety and propofol requirement for anesthesia. Anaesthesia, Pain Intensive Care. 2024;28(1):20–5.
16. Hosseini S, Heydari A, Vakili M, Moghadam S, Tazyky S. 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.
17. Mousavi N, Imani B, Khazaei S, Shams A. The effect of benson relaxation technique and lavender aromatherapy on anxiety and hemodynamic indices of patients undergoing coronary artery bypass grafting: A Randomized clinical trial. J Holist Nurs Midwifery. 2024;34(2):167–76.
18. Amini N, Omidvar S, Zamenjani MN, Harorani M, Modir H. Effectiveness of aromatherapy with lavender compared to progressive muscle relaxation on anxiety and vital signs in patients under spinal anesthesia: A randomized clinical trial. J Integr Nurs. 2024;6(2):90–5.
19. Franco L, Blanck TJJ, Dugan K, Kline R, Shanmugam G, Granell A von B, et al. Both lavender fleur oil and unscented oil aromatherapy reduce preoperative anxiety in breast surgery patients: A randomized trial. J Clin Anesth [Internet]. 2016;33:243–9. Available from: http://dx.doi.org/10.1016/j.jclinane.2016.02.032
20. Beyliklioğlu A, Arslan S. Effect of lavender oil on the anxiety of patients before breast surgery. Journal of Perianesthesia Nursing. 2019;34(3):587–93.
