Discussion
postoperative pain, nausea, lower extremity, fracture, vomiting, pain, fractures, retching, lower extremity fractures, lower extremity fracture, nausea, vomiting
This study showed that lemon inhalation aromatherapy reduced pain intensity in patients with lower extremity fractures upon entering the recovery room and at 4, 12, and 16 h post-surgery. In a mouse model study, the flavonoid eriocitrin in lemon fruit was found to have an antinociceptive effect on postoperative pain. This effect may be mediated by opioid and GABA receptors [This study found that lemon inhalation aromatherapy reduced the severity and frequency of nausea, vomiting, and retching in patients who have undergone surgery for lower extremity fractures. This intervention also reduced the frequency of anti-emetic drug administration in postoperative lower extremity fracture patients. The clinical and important findings were that no patient in the lemon inhalation aromatherapy group needed anti-emetic drugs in the recovery room or 16 h postoperatively, respectively. Similarly, it was revealed that using aromatherapy with lavender, peppermint, ginger, and lemon reduced the number of orthopedic patients’ needs for anti-emetic drugs and their dose of anti-emetic administration [As a cost-effective intervention, lemon inhalation aromatherapy might reduce pain, nausea, and vomiting in patients after lower extremity surgery. Therefore, this intervention had implications in practice.The strength of this study was that the use of lemon essential oil was continued from the morning of the lower limb fracture surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Researchers’ assistant carefully carried out this intervention. Considering inclusion and exclusion criteria carefully minimized the effect of confounding factors, which was another strength of current study. To reduce the other confounders, ANCOVA was used and the type of anesthesia (general or spinal), use of analgesics in pre-,intra-, and post-operative stages, use or non-use of anti-emetic drugs in vomiting in recovery and in the post-operative ward were considered as confounding variables. Using random allocation and large randomized clinical trial was also another strength of this study.Although the patients with lower extremity orthopedic surgery who underwent lemon essential oil indicated lower pain intensity, kind and dose of anesthesia medications might affect the pain feeling in the patients. As it was not possible to control all of these covariates, it was one of the limitations of this study. The second study limitation was related to inclusion criteria that patients with lower extremity fracture surgery (hip, femur, tibia, ankle, and heel) participated in this study. These various types and sites of fractures might affect the symptoms and treatment. Therefore, other studies are recommended to be conducted on one site of fracture, e.g., the hip, femur, tibia, ankle, and heel which received one type of treatment, e.g., open and close reduction and internal and external fixation of the foot.