Comparative Effects of Lavender Aromatherapy and Nature Sounds on Anxiety and Pain in Cataract Surgery Patients: A Randomized Controlled Trial

Abstract

Introduction:

Cataract is one of the most common causes of visual impairment globally, often treated with surgery. Patients undergoing cataract surgery frequently experience anxiety and pain, which can adversely affect their physiological and psychological well-being. This randomized controlled trial aimed to compare the effects of lavender aromatherapy and nature sounds on anxiety and pain in patients undergoing cataract surgery with regional anesthesia.

Methods:

A total of 120 patients were randomly assigned to three groups: lavender aromatherapy, nature sounds, and control. The experimental groups received their respective interventions for 15 min preoperatively, while the control group received standard care. Anxiety and pain were measured using the Spielberger State-Trait Anxiety Inventory and Visual Analog Scale. Data were analyzed using ANOVA and chi-square tests to compare the groups; statistical significance was set at p < 0.05.

Results:

Post-intervention, mean anxiety scores were significantly lower in the lavender (34.85 ± 4.77) and nature sounds (31.95 ± 5.87) groups compared to the control group (49.62 ± 8.70) (P < 0.001). Pain scores following the intervention were reduced in both intervention groups (lavender and nature sounds) compared with the control group. No adverse events were observed in either intervention group. Both lavender aromatherapy (mean difference versus control: –14.8, p < 0.001) and nature sounds (mean difference versus control: –17.7, p < 0.001) significantly reduced anxiety compared to the control group. Results indicated that no adverse events were reported in any group.

Conclusion:

Lavender aromatherapy and nature sounds effectively reduced anxiety and pain in cataract surgery patients, suggesting their potential as non-pharmacological complementary therapies.

Keywords

music therapy aromatherapy anxiety pain cataract

Introduction

Cataracts are one of the most prevalent causes of visual impairment globally,¹ characterized by lens opacity.² Various factors contribute to the development of cataracts, with aging being a significant one.³ The prevalence of cataracts is approximately 50% among individuals aged 65–74 years and increases to 70% in those over 75 years old.⁴ Surgery is the most common intervention for cataract treatment,⁵ performed in many countries to enhance the quality of life for patients of all ages.⁶

Studies have revealed that patients undergoing cataract surgery often experience anxiety in preoperative and intra-operative periods with regional anesthesia. Preoperative anxiety could have an adverse effect on physiological and psychological aspects.⁷ The anxiety prevalence among women is twice that of men.⁸ Anxiety is an unpleasant feeling of worry or pressure caused by the fear of disease, anesthesia, surgery and disability of the organ that has undergone surgery, postoperative complications and hospitalization.⁹ Studies have demonstrated 80% of patients admitted to the hospital suffer from anxiety.¹⁰ Another research showed the mean anxiety score among the patients undergoing cataract surgery was 65–75 in the possible range of 20–80 in State-Trait Anxiety Inventory (STAI).¹¹ Postoperative pain is a complex physiological response to tissue damage. Patients’ main concern in surgery is how much pain they will experience after the operation.¹² Research has revealed that about 80% of patients experience acute pain after surgery. Another investigation indicated pain was a common complication in the early hours after cataract surgery, and its incidence was reported as 34%.¹³

Nowadays, cataract surgery is performed under regional and local anesthesia, and patients may experience pain after the anesthetic drug wears off. Moreover, candidates for cataract surgery are old and likely to have traditional Iranian medicine, underlying diseases such as cardiovascular diseases; complications caused by the use of narcotics and painkillers may be limited. Patients undergoing cataract surgery are typically elderly and often present with a higher prevalence of systemic comorbidities. The management of side effects such as anxiety, pain, nausea, and vomiting with common medications, including opioids, raises concerns and may lead to increased patient sensitivity, as well as the emergence of new complications such as respiratory depression and other systemic side effects. Consequently, the use of complementary and alternative medicine approaches, such as aromatherapy, along with non-pharmacological methods like music therapy and traditional medicine, has become increasingly popular in clinical settings, yielding promising evidence of their efficacy.^14,15 Aromatherapy with medicinal plants is enjoyable and among the ancient sciences focusing on the scent of plant extracts for physical and mental treatment. From the viewpoint, lavender has hot and dry temperament and is suitable for people with cold and wet temperament. From the Iranian Traditional Medicine viewpoint, this plant could be useful for elderly candidates for cataract surgery as well as the elderly having cold Mizaj (temperament). Furthermore, this could strengthen memory and thinking, protect mental health, and make sense of happiness.^16,17 Lavender affects via the limbic system. The active compounds of this plant such as linalool and linalyl acetate cause relaxation and pain relief, respectively. However, studies have shown contradictory results about the effect of this plant on anxiety. Fayazi et al. reported lavender aromatherapy reduced patients’ anxiety before abdominal and heart surgery. Muzzarelli et al. found lavender aromatherapy had no effect on patients’ anxiety before colonoscopy.¹⁸ Music therapy, as a complementary method and one of the seven arts, is another well-accepted non-pharmacological intervention for patients. From the traditional medicine perspective, natural music that has relatively hot or moderate temperament is more compatible with the elderly who have cold temperament. The nature, water, and bird sounds are soothing and compatible with humans’ nature, body and soul. Listening to music is an accessible, cost-effective, and noninvasive method with no side effects.^19–22 Studies have demonstrated that music therapy reduces anxiety.²⁰ Since the patients undergoing cataract surgery are awake and operated under anesthesia, using non-pharmacological methods and complementary medicine could be useful to control their anxiety and pain, considering their age. Therefore, the present study aimed to compare the effects of lavender inhalation and nature sounds on anxiety and pain among patients undergoing cataract surgery with local anesthesia in the eye surgery operating room.

Materials and Methods

This interventional clinical trial with a parallel design involved 120 patients undergoing cataract surgery. The study commenced following ethical approval and registration in a clinical trials registry. The study population consisted of candidates for cataract surgery who received topical anesthesia.

The study population included patients who were referred to the clinic and operating room of Amir al-Momenin Ophthalmology Teaching and Treatment Hospital in Rasht, who were candidates for cataract surgery and received local anesthesia. Inclusion criteria included being 60 years of age or older, having sensitivity to lavender and smell problems, having an anesthesia risk classification of 1 or 2 according to the American Society of Anesthesiologists (ASA I or II), providing written informed consent, and the absence of systemic diseases such as diabetes, metabolic disorders, heart failure, known psychiatric illnesses, and the use of psychiatric medications. Exclusion criteria included deafness, a decision to undergo general anesthesia instead of local anesthesia, drug interventions for severe anxiety, and the patient’s unwillingness or preference against either intervention.

Primary outcome

The primary outcome was the post-intervention anxiety score.

Safety assessment

Safety was assessed through direct clinical observation for adverse events by the research staff during and after the intervention. Any adverse events observed were recorded and reported.

Patient consent and ethical approval

Written informed consent was obtained from all participants prior to their inclusion in the study and before undergoing any intervention or surgery. The study protocol was reviewed and approved by the Ethics Committee of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1401.048). Furthermore, the trial was registered in the Iranian Registry of Clinical Trials (IRCT) and received an official registration code (IRCT ID: IRCT20210927052608N1).

To estimate the sample size for this study, a confidence level of 95% was employed to ensure adequate statistical power (α = 0.05, β = 0.20). Based on the findings from previous studies^23–25 and an initial pilot study conducted with six patients, a mean difference of 3 points in anxiety scores between the intervention groups was anticipated. The mean and standard deviation of anxiety scores in the pilot study were as follows: 33.14 ± 4.16 for the lavender aromatherapy group, 36.25 ± 5.1 for the nature sounds group, and 46.38 ± 5.71 for the control group. Utilizing the sample size formula for comparing means in independent groups, the estimated sample size for each group was approximately 36 participants. To account for a potential dropout rate of 10%, this number was adjusted to 40 participants per group, resulting in a total of 120 participants distributed across the three groups (Fig. 1).

n = \frac{{(Z_{1 - \frac{α}{r}} + Z_{1 - β})}^{r} (δ_{1}^{r} + δ_{Y}^{r})}{{(μ_{1} - μ_{Y})}^{r}}

FIG. 1.

CONSORT 2010 Flow Diagram.

Block randomization was conducted by an experienced statistician to ensure balanced allocation between groups. The three letters A, O, and C were used to represent the groups (A = aromatherapy, O = nature sounds, C = control). Six-letter blocks of unequal order were created, with each letter appearing twice per block (AAOOCC,). Twenty blocks were randomly selected using the online tool (https://www.randomizer.org/). Numbers 1–120 were randomly assigned to represent 120 patients who were consecutively referred for cataract surgery. Patients who met the inclusion and exclusion criteria and provided written informed consent were randomly assigned equally to the three groups. A master coded list, kept confidential by the study coordinator, was used to prepare 120 opaque envelopes, each labeled with a number from 1 to 120. Each envelope contained the type of intervention and was only opened at the time of patient enrollment, after obtaining both verbal and written informed consent. The opaque envelopes were sealed to maintain confidentiality. Outcome assessors for anxiety and pain were blinded to group assignments. Envelopes were opened during the patient visit to determine the assigned intervention. Participants in the ward were physically separated to prevent them from meeting each other, thereby avoiding the exchange of information and knowledge. Additionally, the assessors of postoperative pain and anxiety remained blinded to the treatment allocation throughout the study. Data were analyzed using SPSS software, version 22.0.

Data collection utilized a demographic and disease-related data questionnaire, the STAI, and the Visual Analog Scale (VAS). The 20-item STAI evaluates respondents’ current emotional state. It employs a 4-point Likert scale, with scores ranging from 1 (very little) to 4 (very high). The total anxiety score can range from 20 to 80, with higher scores indicating greater anxiety. Scores of 20–39, 40–59, and 60–80 correspond to mild, moderate, and severe anxiety, respectively. The STAI is widely used in both domestic and international research, with established validity and reliability. Its reliability has been confirmed by a Cronbach’s alpha coefficient of 0.90, and in previous Iranian studies, it was reported as 0.94.²⁶

The pain level was measured by VAS, ranging from 0 to 10–0 represents the absence of pain and 10 indicates the maximum pain. The project started approximately 1 h before the surgery. Patients’ anxiety was measured in the ward and before the intervention. Interventions were carried out separately in each group for 15 min and then, their anxiety was remeasured. Pain was assessed exactly 90 min after the end of surgery for all participants to ensure a uniform evaluation of postoperative pain. For the patients in the lavender group, two drops of Lavandula essential oil²⁷ provided by Alice Pharmaceutical Company, Kazerun, Iran, serial no. 6260207900921 were dripped on a cotton ball and pinned to the collar or placed near the patient’s pillow at a distance of 20 cm from the nose, and the patient was asked to breathe normally for 15 min. Various studies have reported that the effect of scent on anxiety is within 15 min after inhalation.²⁶

The nature sound intervention consisted of a prerecorded, standardized audio file combining beach waves, bird songs, and gentle rain sounds sourced from [Nature Sounds]. The total duration was 15 min, matching the full intervention period for each participant. The audio was delivered through P47 wireless headphones at a consistent, comfortable volume of approximately 60 dB, verified with a decibel meter before each use. This audio file was chosen based on previous studies demonstrating its effectiveness for relaxation in adults and was found to be pleasant and approved to patients during a pilot study. The headphones were disinfected, and the volume level was checked for each new participant to ensure consistency throughout the study.²⁸

The volume of the nature sounds was adjusted to ensure clear audibility for all participants. Headphones were disinfected after each use to prevent infection transmission. Data analysis was performed using SPSS 22.0. For cases with missing data during the study, our analytical approach was intention-to-treat. Anesthesia techniques and medications were standardized across all groups, consisting of Midazolam (0.5–1 mg) and Fentanyl (25–50 μg). Although dosing was individualized within the 0.5–1 mg range, potential effects of dose variability on anxiety and pain outcomes are considered as a study limitation. To evaluate the homogeneity of demographic characteristics among the lavender aromatherapy, nature sounds, and control groups, chi-square tests were used. Categorical variables were analyzed using chi-square or Fisher’s exact test, as appropriate. Continuous variables were compared using ANOVA for normally distributed data, and the Kruskal–Wallis test for non-normal distributions. Pairwise comparisons were conducted using Bonferroni correction to control for multiple testing. A significance level of less than 0.05 was applied for all statistical tests.

Results

The results revealed that the baseline demographic and clinical characteristics of participants in the three groups are presented in Table 1. The distribution of age, gender, and baseline anxiety scores was similar across the lavender, nature sounds, and control groups. Table 2 presents the mean and median anxiety scores based on the STAI for the lavender, nature sounds, and control groups before and after the intervention. Initially, the three groups were similar in terms of baseline anxiety scores. After the intervention, the mean anxiety scores decreased in both the lavender and nature sounds groups compared to the control group. Table 3 provides a binary comparison of mean anxiety scores.

Table 1.

Comparing Patients’ Demographic Characteristics in Three Groups

Variable	Groups	Lavender frequency (percentage)	Nature sounds frequency (percentage)	Control frequency (percentage)	p Value
Age (year)	Mean ± SD	67.50 ± 6.52	65.25 ± 8.56	68.53 ± 8.91	0.18
Gender	Male	20 (16.7)	24 (20)	16 (13.3)	0.20
Gender	Female	20 (16.7)	16 (13.3)	24 (20)	0.20
Marital status	Single	1 (0.8)	2 (1.7)	1 (0.8)	0.50
	Married	34 (28.3)	35 (29.2)	30 (25.00)
	Divorced	0 (0.00)	0 (0.00)	1 (0.8)
	Widow	5 (4.2)	3 (2.5)	8 (6.7)
Educational level	Illiterate and elementary school	27 (22.5)	20 (16.7)	24 (20)	0.47
	High school	8 (6.7)	15 (12.5)	10 (8.3)
	Diploma or higher	5 (4.2)	5 (4.2)	6 (5.0)
Cataract surgery	Right eye	24 (20)	18 (15)	23 (19.2)	0.35
Cataract surgery	Left eye	16 (13.3)	22 (18.3)	17 (14.2)	0.35
Classification of patients’ physical condition	Relatively healthy	7 (5.8)	13 (10.8)	13 (10.8)	0.41
	Mild systemic disease	32 (26.7)	27 (22.5)	26 (21.7)
	Severe systemic disease	1 (0.8)	0 (0.0)	1 (0.8)

Table 2.

Comparing Patients’ Anxiety Before and After Intervention in Lavender Aromatherapy, Nature Sounds and Control Groups

Variable	Time	Before intervention		After intervention
Variable	Group statistic	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)
Anxiety	Lavender	53.80 (4.97)	55 (8)	34.85 ± 4.77	35.5 (7.75)
	Nature sounds	51.67 (6.56)	54 (10)	31.95 ± 5.87	33 (10.5)
	Control	51.07 (7.88)	49.5 (13)	49.62 ± 8.70	50 (12.5)
Kruskal-Wallis test statistic		1.89		81.04
P-value		0.15		<0.001

IQR, Interquartile range; SD, Standard deviation.

Table 3.

Binary Comparison of Mean Anxiety Difference Before and After Intervention

Variable	Group (A)	Group (B)	Mean difference (A–B)	SE	p Value	95% CI
Anxiety before intervention	Lavender	Nature sounds	2.12500	1.47224	0.152	(−0.79–5.04)
	Lavender	Control	2.72500	1.47224	0.067	(−0.19–5.64)
	Nature sounds	Lavender	−2.12500	1.47224	0.152	(−5.04–0.79)
	Nature sounds	Control	0.60000	1.47224	0.684	(−2.31–3.51)
	Control	Lavender	−2.72500	1.47224	0.067	(−5.64–0.19)
	Control	Nature sounds	−0.60000	1.47224	0.684	(−3.51–2.31)
Anxiety after intervention	Lavender	Nature sounds	2.90000	1.48904	0.054	(−0.04–5.84)
	Lavender	Control	−14.77500	1.48904	<0.001	(−17.72 to −11.82)
	Nature sounds	Lavender	−2.90000	1.48904	0.054	(−5.84–0.04)
	Nature sounds	Control	−17.67500	1.48904	<0.001	(−20.62 to −14.72)
	Control	Lavender	14.77500	1.48904	<0.001	(11.82–17.72)
	Control	Nature sounds	17.67500	1.48904	<0.001	(14.72–20.62)

CI, Confidence interval; SE, Standard error.

The pain levels were generally low across all three groups. The mean and median pain levels in the lavender and nature sounds groups were lower than in the control group, with this difference being statistically significant according to the nonparametric Kruskal–Wallis test (Table 4). Table 5 presents a binary comparison of patients’ pain levels. The pain scores following the intervention were reduced in both intervention groups (lavender and nature sounds) compared to the control group. The two intervention groups demonstrated similar levels of pain. No adverse effects were observed in the intervention groups during the study.

Table 4.

Comparing Patients’ Pain in Lavender Aromatherapy, Nature Sounds and Control Groups

Variable	M(SD)	Median (IQR)	Kruskal–Wallis test statistic	p Value
Pain level in lavender group	0.35 (0.48)	0 (1)	42.14	<0.001
Pain level in nature sounds group	0.23 (0.42)	0 (1)
Pain level in control group	1.53 (1.64)	1 (0)

IQR, Interquartile range; SD, Standard deviation.

Table 5.

Comparing Patients’ Pain in the Studied Groups

Group	Statistic	p Value
Lavender and nature sounds	7.06	0.30
Lavender and control	−41.80	<0.001
Nature sounds and control	−34.73	<0.001

Discussion

The results demonstrated that lavender fragrance and nature sounds effectively reduced anxiety and pain in patients undergoing cataract surgery, leading to a further decrease in pain intensity. The observed reductions in anxiety and pain not only reached statistical significance but also represent clinically important improvements for patients. Additionally, these interventions did not cause any complications in the studied groups, and patients readily accepted them. Consistent with our findings, previous studies have shown that lavender aroma and music can effectively reduce anxiety in patients undergoing various surgical procedures. For instance, Abbaszadeh et al. investigated the impact of lavender aroma on anxiety in 80 patients undergoing bone marrow biopsy. They used a few drops of lavender essential oil for 15 min and found that the procedure was associated with significant anxiety, which was alleviated by the lavender aroma.²⁹ Monfard et al. investigated the impact of lavender aromatherapy on anxiety in candidates undergoing endoscopy. A total of 70 eligible patients were selected using convenience sampling. The intervention group received aromatherapy with 10% lavender essential oil for 1 hour prior to endoscopy, while the placebo group received a placebo for 30 min. Subsequently, participants completed an anxiety questionnaire again before the procedure. The results showed a statistically significant decrease in mean anxiety scores in the intervention group compared to the placebo group post-intervention.²⁶ Mesri et al. conducted a study at Qom Hospital involving 64 patients to investigate the impact of lavender aromatherapy on preoperative anxiety in patients undergoing rhinoplasty. Participants inhaled two drops of lavender essential oil placed on sterile gauze for 10–20 min. The results showed that lavender aromatherapy effectively reduced patients’ anxiety, aligning with the findings of the present study.²⁷ Mozaffari et al. found that music therapy was effective in reducing anxiety.³⁰ Melo et al. conducted a study involving 60 patients, divided into an intervention group and a control group of 30 each, to investigate the impact of musical intervention on anxiety and vital parameters in chronic renal patients. The results revealed a significant difference in anxiety levels between the groups during hemodialysis sessions. These findings align with our results, which also demonstrated a reduction in anxiety levels.³¹ Benlioğlu and Çift found that music therapy during shock wave lithotripsy reduced patients’ pain and anxiety scores. Moreover, listening to the patient’s preferred type of music brought more satisfaction.³² Azizi et al. indicated a statistically significant difference in the mean pain intensity after the intervention, so that this difference was significant between the lavender group and placebo and control groups. However, no statistically significant difference was observed between the placebo and control groups.^33,34 Santiváñez-Acosta et al. conducted a review study, entitled “Music Therapy in pain and anxiety Management during Labor.” Research has demonstrated that music therapy has beneficial effects on pain intensity and anxiety during labor, particularly for primparous women. The majority of studies align with our findings regarding the impact of lavender aromatherapy and music therapy on anxiety and pain, suggesting their potential use in future investigations and nursing care as complementary therapies. These results suggest that lavender exerts its anxiolytic effects through stimulation of the parasympathetic nervous system, promoting relaxation. However, Seifi et al. found that lavender essential oil had no significant effect on anxiety in patients’ postcoronary artery bypass surgery, which contrasts with our results, likely due to differences in the study populations.³⁵ Lee et al. compared the effects of musical intervention and aromatherapy on anxiety among patients undergoing mechanical ventilation in the intensive care unit. The results showed music had a greater effect on the anxiety of patients undergoing mechanical ventilation than aromatherapy. This finding was not consistent with our results. while in Lee et al.’s study, the effect of musical intervention was greater than aromatherapy.²³

Clinically, based on the results of the present study, the reduction in anxiety scores for the lavender aromatherapy group compared to the control group was 15 points, while the reduction in the natural sounds group, as a non-pharmacological method, was 18 points. Since no complications were observed in the patients as a result of these interventions, they demonstrate good clinical value. Additionally, the lavender inhalation intervention reduced anxiety by 19 points compared to preintervention levels, and the natural sounds group experienced a reduction of 20 points. In contrast, the control group showed a maximum reduction of only 2 points during simultaneous measurements, indicating that the intervention groups had appropriate clinical value. The difference in anxiety score reduction between the lavender and natural sounds interventions was not significant. Therefore, in similar surgeries, this provides patient caregivers with the flexibility to choose the method they deem most suitable in the clinic.

Although baseline demographic and clinical characteristics were generally balanced between groups, and some confounding factors were controlled through inclusion and exclusion criteria as well as the randomization method used in this study, we acknowledge that certain potential confounders may still have influenced the results. Factors such as a history of mild mental illness, individual preferences for music or aromatherapy, socioeconomic status, and possible concurrent use of anti-anxiety medications unknown to the research team could have impacted the findings. Future studies should consider increasing the sample size and systematically measuring and adjusting for these and other relevant confounding variables to enhance the validity of the results and provide more precise estimates of the intervention’s effects.

Arjmand et al. conducted research on 60 patients to examine the effect of lavender aromatherapy on pain after discectomy surgery. The results revealed lavender aromatherapy had no effect on pain relief after discectomy surgery in the experimental group in the early hours. It was recommended to use this method in acute pain with moderate to mild intensity for controlling pain. This finding was not consistent with our study, probably due to the moderate to mild pain of patients undergoing eye surgery and that could be the reason why aromatherapy had a positive effect.²⁴ Salamatia et al.²⁵ found that inhaling lavender essential oil did not reduce pain in patients undergoing open-heart surgery, which contrasts with our findings. This discrepancy may be attributed to differences in study populations. Inconsistent results across studies could be due to variations in research samples, the degree of surgical invasiveness, the amount and concentration of essential oil used, and the duration of music exposure.

Nasiri et al. aimed to investigate the effect of lavender aromatherapy (Lavandula angustifolia MILL) on headaches following dural puncture. They concluded that while lavender aromatherapy reduces headache intensity immediately after the intervention, its effects are minimal at subsequent time intervals. They also suggested that further research is needed in this area. The results of their study are similar to the findings of the present study regarding clinical pain reduction.³⁶

Based on the findings of the present study, the pain levels in the lavender and natural sounds groups were lower than those in the control group, although the pain scores in all three groups were at levels that did not require pharmacological intervention. Some previous studies have reported similar findings, while others have presented contradictory results. The most likely reason for the discrepancies between the present study and earlier research appears to be the type of surgery involved. For example, cardiac surgery is generally more extensive and riskier compared with cataract surgery, which may account for the differences in outcomes. Therefore, as a preliminary finding, it can be concluded that lavender aromatherapy and listening to natural sounds may reduce the pain levels of patients undergoing cataract surgery, although this finding was not clinically significant.

Limitation

This study has several limitations that should be considered when interpreting its findings. First, although the study was conducted at a major referral center for ophthalmology patients, the fact that it was a single-center study may limit the generalizability of the results to other clinical settings or populations. Second, despite every effort to blind the outcome assessors, it was not possible to fully blind the participants, particularly those in the aromatherapy group. Third, the control group did not receive a placebo intervention such as unscented cotton or neutral sounds, which could introduce bias due to differing treatment experiences; however, the ward setup prevented patients from meeting each other. Fourth, while the sample size was sufficient to detect the primary outcomes, it may not have been large enough to identify rare adverse events or subgroup effects. However, no adverse events such as sensitivity to the interventions, headaches, or other complications were reported by patients in the intervention groups. Finally, the relatively short follow-up period limited the assessment of the long-term effects of the interventions.

We acknowledge that the absence of a placebo equivalent in the control group may introduce psychological bias and recommend that future research include a placebo control group to further strengthen internal validity. Furthermore, investigating the mechanisms and optimal implementation of aromatherapy and sound therapy could facilitate the integration of these complementary, non-pharmacological modalities into routine perioperative care.

Conclusion

The study found that lavender aroma and nature sounds effectively reduced anxiety and pain in patients undergoing cataract surgery. Both interventions not only reduced anxiety and pain but were also well tolerated, with no adverse events observed in any group. These complementary interventions are recommended for similar patient populations due to their convenience, cost-effectiveness, and lack of complications. In light of the demonstrated benefits and absence of adverse effects, we recommend that health care professionals consider offering lavender aromatherapy and nature sounds as Complementary and non-pharmacological options for perioperative anxiety and pain management in cataract surgery candidates. These low-risk interventions are simple to adopt, well tolerated by patients, and may improve overall surgical experience and outcomes when integrated into routine preoperative care.

Authors’ Contributions

R.P.: Writing, original draft, software, formal analysis, data curation, conceptualization. E.N.-F.: Writing, review and editing, supervision, methodology, funding acquisition, conceptualization. A.P.: Writing, original draft, data curation, software. A.S.B.: Writing, original draft, data curation, software. S.H.: Writing data curation, review and editing, supervision, methodology, conceptualization. H.A.: Writing, original draft, data curation, software.

Footnotes

Author Disclosure Statement

The authors declared no conflicts of interest.

Funding Information

This article was taken from the first author’s MSc thesis at Operating Room and Anesthesiology Department, Faculty of Allied Medical Sciences, Mazandaran University of Medical Sciences. Research code-6794-1401. All the authors confirm that the research reported in this article was supported by an institution primarily engaged in education and research.

Supplemental Material

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