Acta Medica Mediterranea, 2016, 32: 1513

ON THE INVESTIGATION OF THE EFFECT OF AROMATHERAPY ON PAIN AFTER ORTHOPEDIC

SURGERY: CLINICAL TRIAL

MAHBOUBEH NAZARI*, FARHAD KAMRANI**, MOHAMMAD SAHEBALZAMANI***, GHOLAM REZA AMIN****

*
Msc student in Nursing ,Department of Nursing, Tehran Medical Sciences Branch, Islamic Azad University,Tehran, Iran -
**
Kamrani F. Faculty member of medical-surgical Department Shahid Beheshti University of medical sciences and Health Services -
***
Associate professor, social Determinants of Health Research Center ,Tehran Medical Sciences Branch Islamic Azad University,
Tehran, Iran - ****Professor, Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center,
Tehran University of Medical Sciences, Tehran, Iran

ABSTRACT

Introduction: Orthopedic surgery is one of the most painful surgeries. This study aimed to investigate the effect of aromathe-
rapy on pain after orthopedic surgery.
Methods: This study is a randomized and controlled clinical trial involving 82 patients undergoing orthopedic surgery of wrist
fracture in randomly selected hospitals of Tehran in 2015. The patients of the treatment group, 8 and 16 hours after surgery, sniffed 3
drops of essential oil of lemon for 20 minutes and the intensity of pain was measured half an hour after the intervention. For the con-
trol group, routine healthcare services continued. Data was analyzed using the SPSS 21 software and descriptive and inferential sta-
tistics. Moreover, in order to measure the effects of aromatherapy and change trends, repeated measures ANOVA was used. Chi-squa-
re test was also used to determine the success rate of the treatment.
Results: Comparison of changes in pain scores between the two groups showed that there is a significant relationship (p=.049)
between the intensity of pain in control and treatment groups during the examined intervals (mean of pain and anxiety reduction 8
and 16 hours after surgery). There was also a significant relationship between the recovery rates of the control and treatment groups
and different intervals (p=.008).
Conclusion: The results of the study indicate a positive impact of aromatherapy with essential oils of lemon on the reduction of
pain, 8 and 16 hours after orthopedic surgery. Therefore, it can be used as a non-pharmacological, inexpensive, and non-invasive
care nursing-method with no complication in the orthopedic surgical sections.

Key words: Pain, aromatherapy, orthopedic surgery.

Received June 30, 2015; Accepted January 02, 2016

Introduction The impact that a fracture puts on the commu-

Distal radius fractures are the most common
upper extremity fractures and approximately 20%
of fractures in the emergency section(1). This frac-
ture account for about half of fractures in emer-
gency orthopedic(2). In 2001, about 640000 distal
radius fractures occurred in America(3). It is over ten
years that surgical intervention in the treatment of
distal radius fractures is increasing(4). This fracture
costs more than $ 240 million annually in
America(5).
nity is beyond the financial damage including pain,
absence from school(4), absence from useful work,
the loss of personal autonomy, and dependency on
others. The most common complaint in these
patients is the remained pain in the wrist ulnar(3).
This type of fracture has a high potential to disrupt
the performance and to bring about immediate com-
plaints(6). The highest incidence of fractures, with
regard to ethnic and gender differences, occurs in
men and women aged 19-49 (4) . The 21.2% of
patients with distal radius fracture may never gain
1514
their mere health after this damage and always have
experienced a decline in their health-related quality
of life(7). The distal radius fracture occurs during the
development of osteoporosis in employed and
active patients(8). Treatment of distal radius fractures
aims at providing the wrist without pain and restor-
ing the anatomy and its required function(4, 9). The
pain refers to unpleasant experience of an emotion-
al sensory that is caused by actual or potential tis-
sue damage and it is the most common reason for
visiting health centers. The pain community of
America considers pain as the fifth vital sign and
suggests that it should be automatically measured
such as pulse and blood pressure(10).
Studies conducted in America showed that the
prevalence of chronic pain after surgery is 60 per-
cent(11). Pain is also common in orthopedic surgeries
because of its nature which always contains muscu-
lar and skeletal tissue reconstruction and reform(12).
Orthopedic surgeons are the third prescribers of
opioid prescriptions among the practitioners of the
United States of America and contribute to drug
epidemic(14). The primary use of opioids cause respi-
ratory depression, hypnotic, drowsiness, itching,
skin rash, urinary retention, delayed stomach and
bowel movements, nausea, and assessment of pain
vomiting(15). Other pain-killer medicines are non-
steroidal anti-inflammatory ones that cause side
effects such as irritation of the gastrointestinal sys-
tem and bleeding, failure or reduced renal insuffi-
ciency, cardiovascular disease and hypersensitivity,
renal dysfunction, inhibited platelet aggregation
(increased risk of bleeding at the surgical site) and
inhibited osteogenesis. The use of these drugs is
limited despite the fact that they are the most com-
mon pain reliever and anti-inflammatory drugs(16).
The presence of trained nurses considering the
importance of early assessment of pain and appro-
priate for postoperative care is vital(17).
Although pharmacotherapy is the most effec-
tive means available to reduce pain, regarding their
side effects, it is important to use these drugs along
with non-pharmacological methods in order to
reduce pain(18). The use of non-pharmaceutical mea-
sures to manage pain such as cryotherapy, relax-
ation, guided imagery, and aromatherapy which are
called complementary therapies are safer than phar-
macotherapy and have fewer side effects. The use
of aromatherapy has clearly increased in compari-
son with other treatment approaches (19) .
Aromatherapy uses essential oils in the form of
inhaler techniques(20) which can reduce pain, mental
Mahboubeh Nazari, Farhad Kamrani et Al
stress, and depression and improve vital signs(21).
Fragrances induce relaxation by stimulating the
olfactory system using essential oils (22) .
Aromatherapy is used to relieve pain, anxiety,
depression, insomnia, fatigue, asthma and even to
create self-confidence, success, and creativity(23).
Today, aromatherapy via using essential oils of
lemon peel is common and is used to reduce anxi-
ety and depression and to strengthens the nerves
and so on(24). The lemon essential oil is a safe herbal
remedy to reduce nausea and vomiting in pregnan-
cy(25). The essential oil of lemon has shown an anal-
gesic effect through the descending inhibitory sys-
tem of mice(26). Given the importance of reducing
the postoperative complications and recognizing
that analgesic pharmaceutical techniques bear side
effects such as nausea and vomiting, tolerance, itch-
ing, urinary retention, respiratory depression and
depressiveness, the use of complementary medi-
cine, hence, will be a better alternative.
According to the aforementioned issues, the
implementation of this issue seems difficult because
of conflicting results of previous studies. In order to
eliminate the problems faced in the previous
research studies and to provide access to easier and
effective techniques, as well as the need to have
further investigation in this regard, the researchers
came up with a study to evaluate the effect of aro-
matherapy on pain in patients undergoing orthope-
dic surgery. If the effectiveness of complementary
medicine in controlling pain is proved in this study,
patients will be significantly helped.
Materials and methods
In this randomized controlled trial, the effects
of inhaled aromatherapy on the pain of the patients
undergoing orthopedic surgery (distal radius frac-
ture) was investigated in the selected hospitals of
Medical Sciences Department of Shahid Beheshti
including Ayatollah Taleghani, Imam Hussein (AS),
Akhtar hospitals. Since that study had one depen-
dent variable (i.e. pain), 82 patients were randomly
selected based on the random selection Table and
were replaced with regard to the pre-test scores in
the treatment and control groups (each group 41
persons). The minimum of sample size for each
group was determined by the sample size equation.
On the investigation of the effect of aromatherapy on pain after orthopedic surgery ... 1515

n1=n2 a non-absorbent cloth and then it was pinned to the

= 0.05 patient's collar for 30 minutes. After that, the pain
was re-measured by Visual Analogue Scale. The
The instrument used to collect data was a two-
control group continued to receive routine care ser-
section questionnaire whose information gathered
vices. After collecting demographic information in
through interviews .The first section of the ques-
the questionnaire, the chi-square and gamma analy-
tionnaire was related to socio-demographic charac-
ses were used to evaluate the difference between
teristics such as age, sex, marital status, BMI, occu-
variables in two groups. The effects of aromathera-
pation, education, income, insurance status, and
py and its change trends were measured using
disease-related information including history of
repeated measures ANOVA. Chi-square test was
hospitalization, surgery, painkiller and its dose, the
also used to determine the success rate of the treat-
type of anesthesia. The content validity of the ques-
ment and the research hypotheses were tested at the
tionnaire was confirmed by Seyed Rasouli, et al(28)
Alpha level of 0.05.
and it need no reliability measurement due to its
being checklist. The second section of the question-
Results
naire consisted of visual analogue scale (VAS) to
measure the patients' pain. It was ranked from 0 (no
The mean age for the control group and treat-
pain) to 10 (severe pain). Reliability and validity of
ment group was 39.78% and 35.68%, respectively.
the VAS pain assessment tool for measuring anxiety
In this study, 31 male patients (75.6%) and 10
and pain has already been approved in Iran (29).
female patients (24.4%) were present in the control
Canada has also confirmed the validity of the
group. In the treatment group, 26 male patients
scale(30). The reliability of this instrument in Iran is
(63.4%) and 15 female patients (36.6%) were pre-
reported to be r = 0.83 (31). The reliability of the
sent. In this study, 41.5% of patients in the control
instrument in Canada for illiterate and literate peo-
group hold diploma and 73.2 percent of participant
ple is r = 0.94 (p <0.001) and r=.71 (p <0.001),
in the treatment group were married. In this study,
respectively(30). Inclusion criteria for the study were
51.2% of patients in the control group were clerks
male and female patients aged 15 - 55, patients
with the highest employment percentage. In this
undergoing orthopedic surgery (distal radius), hav-
study, 95.1 % of participants in the control group
ing the same surgeon, avoiding the use of anti-anxi-
and 93.9% of participants in the treatment group
ety drugs and herbal medicines, drug addiction
claimed that they spent more than their income. In
(according to the patients), not being involved in
This study, 68.3 percent of patients in the treatment
health care works, not suffering from visual, audito-
group had a history of hospitalization and there was
ry, olfactory, respiratory, allergic, hepatic and renal
a significant difference between these two groups
problems.
with regard to history of hospitalization (p=0.044).
In the case of unwillingness to continue and
In this study, 78% of people in the treatment group
presence of surgical side effects, participants were
had insurance ID and there was also a significant
excluded at each stage of intervention (aromathera-
difference in these two groups in this regard
py). Sampling started on March 21, 2015 and com-
(p=0.027). Most participants of the study in both
pleted on June 21, 2015. First written consent forms
control (70.7%) and treatment groups had normal
were obtained from the participants of the study.
BMI.
The independent variable, i.e. pure essential oil of
The analysis of repeated measures ANOVA
lemon, was prepared in the laboratory of Institute of
(Table 1) shows there is a significant relationship
Medicinal Plants, Tehran University. To ensure its
between pain intensity in both groups and examined
purity and to accurately determine its components,
intervals (p=0.049).
GC and GCMASS tests were carried out and its D-
F statistic d.f. p-value
limonene was determined. Due to its toxic dose, 1
drop per 20 kg body weight was estimated. 738.72 1 0 Time

The procedures were as follows. First, the base 7.82 1 0 Group

pain was measures at 9 pm before the surgery and
4.11 1 0.049 Time * Group
before the intervention as well as 8 and 16 hours
after surgery while they had received the last dose Test: Repeated Measures ANOVA

of injected sedative 3 hours earlier. Then, 2 drops of Table 1: Comparing the intensity of pain prior to and after
essential oil of lemon was dropped by a dropper on intervention between therapeutic and control groups.
1516 Mahboubeh Nazari, Farhad Kamrani et Al

46.3% recovery were observed for the treatment and

control groups, respectively. Moreover, 16 hours after
intervention and measuring the recovery rate in com-
parison to this rate at 8 hours after the intervention,
rates of 56.1% and 17.1% in the treatment group and
the control group were observed (table 3). Using these
results, it can generally be said that the recovery rate
in the treatment group was higher than that in the con-
trol group and recovery trend has increased over time.
The results can be seen in Figure 3.
Fig. 1: Comparing the intensity of pain prior to and after
intervention between treatment and control groups.
As it is shown in Figure 1, the pain intensity is
almost identical for both groups at baseline and pre-
intervention. Eight hours after the intervention,
although there is a reduction in the pain intensity
for both groups, it can be said that the rate of
decline is identical in both groups. However, with
the lapse of time and then measuring the pain inten-
sity 16 hours after treatment, the pain decrease in Fig. 2: Comparing the means of pain intensity in control
the treatment group has occurred faster than in the and treatment groups during the examined intervals.
control group.
The results of pain intensity means (Table 2) and treatment control
the distribution of the pain intensity or the patients in Recovery
frequency percent frequency percent
the control and treatment groups at the examined
24 58.5 19 46.3 Yes
intervals showed that the pre-intervention mean for The first intervention to
pre-intervention
the control group and the treatment group was 9.07 17 41.5 22 53.7 No

and 8.68, respectively. As it is observed, the difference 23 56.1 7 17.1 Yes

The second intervention
between these two groups is non-significant. Eight to the first intervention
18 43.9 34 82.9 No
hours after intervention, the pain intensity has reduced
40 97.6 36 87.8 Yes
in both treatment and control groups and speed of this The second intervention
to pre- intervention
decline is almost identical in both groups. As it can be 1 2.4 5 12.2 No

seen in Table 2, mean scores changed to 6.52 and
6.15. Sixteen hours after the intervention, there was
also a decline in both groups; however, the rate of
decline was higher in the treatment group (fig. 2).
treatment
Table 3: Recovery frequency distribution for participa-
ting patients in control and treatment group.
control

Mean s.d. Mean s.d.

prior to intervention 8.68 1.45 9.07 1.08

16 Hours after intervention

8 hours after intervention 6.15 0.96 6.52 0.95

16 hours after interven-

3.68 1.57 4.68 1.11 Fig. 3: Recovery frequency distribution for participating
tion
patients in control and treatment groups.
Table 2: Distribution of the pain intensity in control and
treatment groups during the examined intervals. Table 4 has evaluated the recovery rate. The
recovery rate in each pain reduction phase is consid-
Generally, total recovery, i.e. the patients recov-
ered at least three degrees of intensity. According to
ery at end of the study and after measuring the pain
the test results, it can be mentioned that there is a sig-
intensity at 16 hours after intervention, was equal to
nificant relationship between the recovery rate in both
97.6 and 87.8 in control and treatment groups, respec-
groups and different intervals (p=.008) (Fig. 4).
tively. As it can be seen this rate is higher in the treat-
ment group. Eight hours after intervention, 58.5% and
On the investigation of the effect of aromatherapy on pain after orthopedic surgery ...
D.f. Wald statistic p-value
Recovery time 1 0.177 0.674
Group 2 35.48 0 lavender essential oil during episiotomy recovery.
Time * Group 2 9.61 0.008
Test: GEE model
Table 4: Comparing the recovery rate of patients
between control and treatment groups.
* Interaction of position with group variable
Fig. 4: Comparing the recovery rate of patients between
control and treatment groups.
Discussion
The findings has showed that inhaled aromather-
apy with essential oils of lemon has a significant
impact on pain reduction in patients undergoing ortho-
pedic surgery of distal radius. Aromatherapy reduced
the patients overall pain during 8 and 16 hours after
intervention.
The results of this study are in the same line with
the results of aromatherapy studies including the Yang
Sak Johns et al. (2013) case study entitled The effect
of inhalation of eucalyptus essential oil on inflamma-
tion and pain after knee replacement surgery indicat-
ing a significant post-operational pain reduction after
the inhalation of eucalyptus essential oil (p <0.001)(32)
as well as the study conducted by Sue Hai Hang
(2014) entitled. The effects of aromatherapy with
lavender essential oil on pain reduction after arthro-
scopic knee surgery indicationd a significant
decrease in pain intensity after surgery (p=0.002)(33)
and Olapours et al. (2013) study entitled. The effects
of aromatherapy with lavender essential oil on pain
reduction after cesarean surgery: A complementary
treatment (p=0.001)(34).
The result of this research study is not consistent
with those of Salamatis et al. (2014) study entitled.
The impact of inhaling lavender essential oil on pain
reduction after open heart surgery. The results
showed that inhaled aromatherapy technique has no
impact on reducing pain after open heart surgery (p>
0.05)(35).
1517
The obtained results also significantly differed
from those of the study carried out by Vakiliyan et al.
(2011) entitled The benefits of regeneration with
The pain rate showed no significant difference (P =
0/06) for treatment and control groups(36).
The results of this study is also not consistent
with those of the study conducted by Kim JT, et al
(2006), which aimed to evaluate the effects of aro-
matherapy on pain after breast biopsy surgery per-
formed in New York. It directly rejected the effect of
aromatherapy as a painkiller. Patients in the group
using lavender essential oil were only more satisfied
than patients in the control group with regard to pain
control (p = 0.0001)(37).
In Iran, no similar study has been conducted with
regard to inhalned aromatherapy in reducing pain after
orthopedic surgery. The studies on patients with physi-
cal diseases have not confirmed the effects of aro-
matherapy on pain relief(35, 36, 37). According to the
results of this study, it seems that using aromatherapy
has a significant impact on pain reduction; however,
this effect is not confirmed with regard to physical dis-
eases. But its effect on pain reduction in patients
undergoing painful surgeries and procedures has been
approved. It seems that further research is necessary to
interpret the differences of effectiveness. Nevertheless,
aromatherapy can be used to as a complementary or
alternative method for other treatment methods(38,39,40).
Undoubtedly, the positive effects of this method can
provide a useful treatment for those who are at risk of
complications of narcotics and non-steroidal and anti-
inflammatory drugs, reduce the individual, family,
school and community consequences which are linked
to pain relief, and prevent the progression of symp-
toms and the severity of the disability after surgery by
faster relief from pain. It seems that further research-
in this regard after other types of surgeries, especially
in combination and comparison with other pharma-
cotherapy, cognitive, and behavioral methods- is nec-
essary to determine the effectiveness of this technique.
References
1) Sanjeev Kakar (2015) Clinical Faceoff: Controversies
in the Management of Distal Radius Fractures. Clinical
Orthopaedics and related Research. Vol. 473(10), pp:
3098-3104 First online: 21 May 2015 / DOI
10.1007/s11999-015-4335-5
2) Soleiman pour J., Ghorbanzade M, Ganjpor sales,
Eslamian F, (2011). Comparison of Outcomes and
Complications of 1- and 4-week Cast Immobilization
after Distal Radius Fracture. Journal of Kerman
1518
University of Medical Science .Vol. 18 (1). pp: 49-54
50.
3) A.R. Sadeghifar, A .Heshmaty, A.R. Saied, A.
Ayatollahi Mousavi, A.R. Pooladsanj, F. Arabnejhad
(2014). The Effect of Prophylactic Corticosteroid
Injection in Decreasing the Ulnar Sided Wrist Pain in
Patients with Acute Distal Radius Fracture. J Babol
Univ Med Sci; 16(7). pp. 7-13 7
4) Nellans KW, Kowalski E, Chung KC (2012). The epi-
demiology of distal radius fractures. Hand Clin Vol;
28(2): 113-25.
5) Shauver MJ, Yin H, Banerjee M, Chung KC (2011).
Current and future national costs to medicare for the
treatment of distal radius fracture in the elderly. J
Hand Surg Am. VOL (36). PP: 1282-1287.
6) Iyer, K. Mohan (2013). Trauma Management in
Orthopedics. 1 ed. Springer-Verlag London. P. 234
eBook ISBN: 978-1-4471-4462-5 DOI: 10.1007/978-1-
4471-4462-5
7) Van Son MA, De Vries J, Roukema JA, Den Oudsten
BL (2013). Health status and (health-related) quality of
life during the recovery of distal radius fractures: a
systematic review. Qual Life Res. Vol; 22.pp:2399416.
doi: 10.1007/s11136-013-0391-z.
8) P. Lips et al (2010). Validation of the IOF quality of life
questionnaire for patients with wrist fracture.
Osteoporos Int .Vol 21. PP. 6170 DOI
10.1007/s00198-009-0946-6
9) Jafari D, Najd Mazhar F, Jalili A, Zare S, Hoseini
Teshnizi S(2013). The Inter and intraobserver reliabili-
ty of measurements of the distal radius radiographic
indices. Shafa Orthopedic Journal. 2013.1(2): 22-25.
10) Smeltzer CS and Brenda GB. (2014). Brunner and
Sudarths Textbook of Medical-Surgical Nursing. 10th
ed. Lippincott Williams and Wilkins, Philadelphia pp:
231. (p: 2364).
11) Morshedi A, Dashti - R M, Dehghan - H M,
Bagherinasab M, Salami A (2011). The Effect of
Artemisia sieberi Besser on Infkammatory and
Neurogenic Pain in Mice. JMP. Vol; 4 (40): 48-57 URL
http://www.jmp.ir/browse.php?a_code=A-10-154-
1&slc_lang=fa&sid=1
12) Buyukyilmaz FE, Asti (2010). Postoperative pain char-
acteristics in Turkish orthopedic patients. Pain Manag
Nurs; 11(2): 76-84.
13) Ko YL, Lin PC (2012). The effect of using a relaxation
tape on pulse, respiration, blood pressure and anxiety
levels of surgical patients. J Clin Nurs; 21(5-6):689-97.
14) Morris BJ, Mir HR (2015). The opioid epidemic:
Impact on orthopaedic surgery. J Am Acad Orthop
Surg. Vol 23(5).PP:267-271 doi: 10.5435/JAAOS-D-
14-00163 http://www.ncbi.nlm.nih.gov/pubmed
/25911660
15) Jahr JS, Filocamo P, Singh S (2013). Intravenous
acetaminophen: a review of pharmacoeconomic sci-
ence for perioperative use. Am J Ther Vol: 20. PP: 189-
99.
16) Ippokratis Pountos, et al (2012). Do Nonsteroidal Anti-
Inflammatory Drugs Affect Bone Healing? A Critical
Analysis. The Scientific World Journal. Volume 2012,
Article ID 606404, 14 pages Review Article
doi:10.1100/2012/606404
17) Dorr LD, Chao L (2007). The emotional state of the
patient after total hip and knee arthroplasty. Clin
Mahboubeh Nazari, Farhad Kamrani et Al
Orthop Relat Res .Vol ;( 463). PP: 7-12.
18) Bagherinesami M, Zargar N, Baradari AG, Khalilian A
(2012). The Effect of Foot Reflexology Massage on
pain and Fatigue of Patients Undergoing Coronary
Artery Bypass Graft (persian). Mazandaran Univ Med
Sci Vol.; 22(92):56-62.
19) Fayazi S, Babashahi M, Rezaei M (2011). The effect of
inhalation aromatherapy on anxiety level of the
patients in preoperative period. Iran J Nurs Midwifery
Res.Vol 16(4). Pages 278-283.
20) Myung-Haeng Hur, Myeong Soo Lee, Chan Kim and
Edzard Ernst (2012). Aromatherapy for treatment of
hypertension: a systematic review. Journal of
Evaluation in Clinical Practice. Vol. 18(1), pages
3741, February 2012 DOI: 10.1111/j.1365-
2753.2010.01521.x
21) Ali Bikmoradi, Zahra Seifi, Jalal Poorolajal, Malihe
Araghchian, Reza Safiaryan, Khodayar Oshvandi
(2015). Effect Of inhalation aromatherapy with laven-
der essential oil on stress and vital signs.
Complementary Therapies in Medicine Vol. 23, Pages
331-338 http://dx.doi.org/10.1016/j.ctim.2014.12.001
22) Valipour NS, Kheirkhah M, Neisani L, Haghani H
(2012). Comparison of the effects of aromatherapy with
essential oils of damask rose and hot footbath on the
first stage of labor anxiety in Nulliparous women.
Complement Med. J. Faculty Nurs. Midwifery. VOL. 2
(2): 1-9.
23) Sahebalzamin M, Khanavi M, Alvi majd H, Mirkarimi
S, Karimi M. (2010). Effects of inhalation aromathera-
py on female students' anxiety and depression settling
in dormitory of Tehran University of Medical Sciences.
J; Islamic Azad University Tehran Branch. Vol. 2(3).
pp: 175-181.
24) Maghsoudi Shahram. Lemontherapy. 1 st ed. Iran.
Tehran: Agriculture Science; 2012.P:156 ISBN: 978-
964-683283-1
25) Lua PL, Zakaria NS (2012). Abrief review of current
scientific evidence involving aromatherapy use for nau-
sea and vomiting. J Altern Complement Med; 18(6):
534-40.
26) Hiroshi Ikeda, Syuntaro Takasu and Kazuyuki Murase
(2014). Contribution of anterior cingulate cortex and
descending pain inhibitory system to analgesic effect of
lemon odor in mice. Mol Pain. 2014; 10 (14).pp:1-8
doi: 10.1186/1744-8069-10-14 PMCID: PMC3936890
27) Heydar Noroozinia H, Mahoori A, Hassani E, Akhbari
P. Diclofenac suppository versus intramuscular pethi-
dine in post herniorrhaphy pain relief. (persian).
Tehran Univ Med J 2011; 69(3): 198-203.
28) Vahid Zamanzade, Alehe Seyyedrasooli, Kobra Parvan,
Mehdi Aghakeshizade (2015). The effect of music on
anxiety and pain in patients undergoing cholecystecto-
my. Medical - Surgical Nursing Journal, Vol; 3(4): 203-
209.
29) Mohseni M, Ebneshahidi A, Yazdkhasti P(2012). The
effect of patient-selected music on early postoperative
pain, anxiety, and hemodynamic profile in cesarean
section surgery. Anesth Pain Med. Vol; 2(7): 88-95.
30) Gillian A. Hawker, Samra Mian, Tetyana Kendzerska,
and Melissa French (2011). Measures of Adult Pain.
Arthritis Care & Research. Vol. 63, No. S11, pp S240-
S252 DOI 10.1002/acr.20543
On the investigation of the effect of aromatherapy on pain after orthopedic surgery ... 1519

31) Mahboobeh Kafaei Atrian, Fatemeh Abbaszadeh,

Malihe Sarvieh, Nahid Sarafraz, Mohammad Asghari
Jafarabadi (2013). Investigatingthe Effect of Pressure
on Third Liver Point on Primary Dysmenorrhea: a
Randomized Controlled Clinical Trial. Iranian Red
Crescent Medical Journal .Vol; 15(9): 6 pages e12719
(InPress). DOI: 10.5812/ircmj.12719
32) Jun YS, Kang P, Min SS, Lee JM, Kim HK, Seol
GH(2013). Effect of eucalyptus oil inhalation on pain
and inflammatory responses after total knee replace-
ment: a randomized clinical trial. Evid Based
Complement Alternat Med. Vol 2013; Article ID
502727. 7 pages doi: 10.1155/2013/502727. Epub 2013
Jun 18.
33) Su-Hui Huang, Li Fang, Shu-Hui Fang (2014). The
Effectiveness of Aromatherapy with Lavender Essential
Oil in Relieving Post Arthroscopy Pain. JMED
Research, Volume 2014. 9 pages.
34) Olapour A, Behaeen K, Akhondzadeh R, Soltani F, Al
Sadat Razavi F, Bekhradi R.(2013). The Effect of
Inhalation of Aromatherapy Blend containing Lavender
Essential Oil on Cesarean Postoperative Pain. Anesth
Pain. Vol 3(1):203-7. DOI:10.5812/aapm.9570
35) Salamati Armaiti, Mashouf Soheyla, Sahbaei, Faezeh
and Mojab Faraz (2014). Effects of Inhalation of
Lavender Essential Oil on Open-heart Surgery Pain.
Iranian Journal of Pharmaceutical Research (2014), 13
(4): 1257-1261.
36) Katayon Vakilian Mahtab Atarha, Reza Bekhradi, Reza
Chaman (2011). Healing advantages of lavender essen-
tial oil during episiotomy recovery a clinical trial.
Complementary Therapies in Clinical Practice.Vol 17.
50 e 53 doi:10.1016/j.ctcp.2010.05.006
37) Kim JT, Wajda M, Cuff G, Serota D, Schlame M,
Axelrod DM, Guth AA, Bekker AY(2006). Evaluation
of aromatherapy in treating postoperative pain: pilot
study. Pain Pract. 6(4). 273-277.
38) Abedi Gh, Azimehr L, Rostami F. Mohammadi, S.
Applying a model of patients right in the state hospital,
Sari, Iran. International Journal of Collaborative
Research on Internal Medicine and Public Health.
February 2012; 4(2): 103-110.
39) Abedi Gh. Ahmadi A. Rostami F. Assessment of quality
of life in hepatitis B patients compared with healthy
people. Life Science Journal, 2012; 9 (4): 5339-5343.
40) Abedi, Gh, Mohammadi, A., Mohammadi, F, Alizadeh,
A, Hosseini, H, Rostami, F. University students person-
ality profile based on casta & MaCrea five factor theo-
ry. International Journal of Collaborative Research on
Internal Medicine and Publi

Acknowledgments
This article is extracted from the thesis approved by the Ethics _______
Committee of the Islamic Azad University with code No. 1045- Corresponding author
12 / 93 and is registered in the clinical trial database under No. MAHBOUBEH NAZARI
IRCT2015081723655N1. I would like to express my gratitude Msc student in Nursing, Department of Nursing, Tehran
to dear authorities of Medical Sciences Department of Shahid Medical Sciences Branch, Islamic Azad University
Beheshti University and the personnel of selected hospitals of Tehran
the university and all patients who participated in the study. (Iran)
mahnazari2010@yahoo.com