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Herbal medications for anxiety, depression, pain, nausea and vomiting related to preoperative surgical patients: a systematic review and meta-analysis of randomised controlled trials
  1. Ana Paula Nappi Arruda1,
  2. Yuchen Zhang2,
  3. Huda Gomaa3,
  4. Cristiane de Cássia Bergamaschi4,
  5. Caio Chaves Guimaraes5,
  6. Leonardo A R Righesso6,
  7. Mariana Del Grossi Paglia7,
  8. Silvio Barberato-Filho4,
  9. Luciane Cruz Lopes4,
  10. Ana Patricia Ayala Melendez8,
  11. Luciane Dias de Oliveira9,
  12. Lucas Paula-Ramos9,
  13. Bradley Johnston10,
  14. Regina El Dib9,11
  1. 1 Department of Surgery and Orthopedics, UNESP - Universidade Estadual Paulista, Faculty of Medicine, Botucatu, São Paulo, Brazil
  2. 2 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
  4. 4 Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
  5. 5 Terapeutica, Faculdade Sao Leopoldo Mandic, Campinas, Brazil
  6. 6 Oral & Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
  7. 7 Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
  8. 8 Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
  9. 9 Department of Biosciences and Oral Diagnosis, UNESP – Universidade Estadual Paulista, Institute of Science and Technology, São José dos Campos, Brazil
  10. 10 Community Health and Epidemiology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  11. 11 St. Joseph’s Healthcare, McMaster University, Institute of Urology, Hamilton, Ontario, Canada
  1. Correspondence to Dr Ana Paula Nappi Arruda; ana_nappi{at}


Objective To summarise the effects of herbal medications for the prevention of anxiety, depression, pain, and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgical procedures.

Methods Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and LILACS up until January 2018 were performed to identify randomised controlled trials (RCTs). We included RCTs or quasi-RCTs evaluating any herbal medication among adults undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgeries. The primary outcomes were anxiety, depression, pain and PONV. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence for each outcome.

Results Eleven trials including 693 patients were eligible. Results from three RCTs suggested a statistically significant reduction in vomiting (relative risk/risk ratio (RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96) with the use of Zingiber officinale (ginger) compared with placebo in both laparoscopic and obstetrical/gynaecological surgeries. Results suggested a non-statistically significantly reduction in the need for rescue medication for pain (RR 0.52; 95% CI 0.13 to 2.13) with Rosa damascena (damask rose) and ginger compared with placebo in laparoscopic and obstetrical/gynaecological surgery. None of the included studies reported on adverse events (AEs).

Conclusions There is very low-certainty evidence regarding the efficacy of both Zingiber officinale and Rosa damascena in reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer), nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752 more) in patients undergoing either laparoscopic or obstetrical/gynaecological surgeries. Among our eligible studies, there was no reported evidence on AEs.

PROSPERO registration number CRD42016042838

  • herbal, laparoscopy
  • gynecologic surgery
  • obstetrical surgery
  • cardiovascular surgery
  • systematic review

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  • Contributors APNA: Conceived the review, undertook the searches, screened search results, extracted data from papers, wrote to authors of papers for additional information, contributed in analysing RevMan statistical data, contributed in making statistical inferences, interpreted the data, wrote the review and revised the manuscript. RED: conceived the review, supervise the whole manuscript, contributed in analysing RevMan statistical data, contributed in making statistical inferences, interpreted the data, wrote the review, and revised the manuscript. APA was the Trial Search Coordinator responsible for the search strategy. CCB, YZ, HG, CCG, LARR, MDGM, SBF, LDO, LPR and LCL screened search results and extracted data from papers. BCJ: interpreted and analysed the data and revised the manuscript. All authors read and approved the final manuscript.

  • Funding RED was supported by Brazilian Research Council (CNPq) scholarship grant number (CNPq 310953/2015-4).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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