A randomized trial conducted at Sanbo Brain Hospital in Beijing, China, suggested that aromatherapy with lavender (Lavandula angustifolia) essential oil may play a relevant role in the postoperative care of patients with brain tumors.

The intervention, administered for 7 consecutive nights, resulted in significant improvement in sleep quality, especially on the 4th night after surgery, in addition to reducing the duration of postoperative delirium and alleviating symptoms of anxiety. 

Study Findings

Sleep disturbances and neurocognitive dysfunction are common complications following intracranial surgery. These affect both clinical recovery and the mental health of patients. 

These changes are linked to longer hospital stays, higher costs, and cognitive decline.

Drug treatments can help but increase the risk for respiratory depression, tolerance, and dependence; therefore, nonpharmacologic alternatives are of increasing interest. 

Aromatherapy is easy to apply and has a favorable safety profile. “Identifying effective and safe strategies to improve sleep quality during the perioperative period is of great significance for optimizing clinical outcomes,” the authors wrote.

The study enrolled 42 adults who underwent elective craniotomy between July and October 2023. Participants were randomized to receive either five drops of 10% lavender essential oil applied to nasal patches nightly from 8:00 PM to 8:00 AM for 7 nights or no intervention. 

The lavender essential oil used was carefully analyzed by chromatography and showed high concentrations of linalool and linalyl acetate, which are compounds associated with anxiolytic and sleep-modulating effects.

Sleep was monitored using a portable device previously validated against polysomnography, which is the gold standard for sleep assessment.

Delirium and cognition were assessed using the Confusion Assessment Method (CAM) for the ICU and the Mini-Mental State Examination (MMSE). The CAM-ICU is a validated tool for diagnosing delirium in patients who are critically ill, including those unable to communicate verbally.

The MMSE is a brief assessment of global cognitive function that evaluates orientation, memory, attention, language, and constructive skills and is widely used to screen for cognitive deficits in clinical settings.

On the 4th postoperative night, the patients receiving lavender essential oil vs no intervention slept an average of 29 minutes longer (418.5 min vs 389.6 min; P = .019). Time in deep sleep was greater in the intervention vs nonintervention arm (95.1 min vs 66.9 min; P = .002).

Moreover, in the intervention vs nonintervention group, sleep latency was shorter (13.2 min vs 28.6 min; P = .002). The apnea-hypopnea index declined, and nocturnal awakenings were less frequent in the intervention group.

The mean duration of postoperative delirium was shorter in patients who did vs did not receive lavender essential oil (2.0 days vs 3.8 days, P = .048). 

On the 7th postoperative day, anxiety scores were almost 50% lower with vs without intervention (3.4 vs 6.1; P = .038).

“These findings suggest a potential delayed or cumulative effect of repeated lavender essential oil exposure, which may require several nights to exert a measurable impact on postoperative sleep quality,” the authors noted.

Supporting Evidence

The trial findings are consistent with those of previous studies.

A systematic review and meta-analysis evaluated aromatherapy with lavender essential oil during hemodialysis over 4 weeks and reported significant reductions in fatigue and anxiety.

In a 4-week trial in São Paulo, Brazil, the use of lavender essential oil and sleep hygiene guidance was effective in improving the quality of life, sleep patterns, and self-reported hot flashes in postmenopausal women with insomnia.

These findings suggest that lavender can serve as an adjuvant during biological transition phases, modulating emotional and physiological factors linked to sleep.

Two meta-analyses have evaluated the use of lavender oil in insomnia in patients with cancer, showing consistent improvements in sleep quality compared with placebo or usual care. As patients with cancer often experience pain, anxiety, and sleep disturbances, these findings align with the trial results, which focused on patients after intracranial tumor surgery.

In more severe cases, studies in intermediate care units have reported that aromatherapy reduces plasma cortisol levels, stabilizes vital signs, and improves self-reported sleep quality.

These results offer insights into the potential mechanisms of lavender oil and help explain the objective improvements observed in the trial, including longer deep sleep and lower anxiety.

A double-blind, randomized trial conducted in Brazil evaluated preoperative lavender aromatherapy in 102 adults who underwent third molar extraction. Anxiety scores decreased significantly after inhalation (P = .009) in the intervention group but not in the placebo group.

Systolic and diastolic blood pressure decreased transiently in both groups, whereas other vital signs remained stable. Overall, lavender reduced preoperative anxiety and supported hemodynamic stability.

These findings demonstrate the short-latency anxiolytic effect of lavender in a surgical setting and are consistent with a neurosurgical trial showing that 7 nights of lavender use sustained improvements in postoperative sleep and anxiety.

Limitations

The authors noted several limitations, including a small sample size, single-center design, and absence of placebo group. In addition, the lavender variety used (Jingxun 2) has a unique chemical composition that may differ from that of oils available in other regions. However, its long-term safety remains uncertain.

Case reports in The New England Journal of Medicine have linked topical lavender to prepubertal gynecomastia, possibly due to the estrogenic effects of compounds such as linalool and linalyl acetate. Short-term aromatherapy appears to be safe; however, larger trials with longer follow-up periods are required.

Future Directions

Researchers aim to conduct larger multicenter trials to evaluate the effects of lavender on sleep, recovery, and quality of life while exploring its interaction with gamma-aminobutyric acid receptors and limbic pathways.

“These findings hold significant implications for clinicians seeking to improve perioperative sleep, mitigate cognitive impairment, and manage stress using lavender essential oil,” the authors concluded.

This story was translated from Medscape’s Portuguese edition.