Nurs Midwifery Stud. 2015 June; 4(2): e28625.

DOI: http://dx.doi.org/10.17795/nmsjournal28625
Research Article

Published online 2015 June 27.

Ginger Essence Effect on Nausea and Vomiting After Open and Laparoscopic
Nephrectomies
1

Fatemeh Sadat Hosseini ; Mohsen Adib-Hajbaghery

2,*

1Labbafinejad Hospital, Tehran University of Medical Sciences, Tehran, IR Iran

2Trauma Nursing Research Center, Faculty of Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
*Corresponding author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Faculty of Nursing, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-36155540021,
Fax: +98-3615556633, E-mail: [email protected]

Received: March 11, 2015; Revised: April 4, 2015; Accepted: April 5, 2015

Background: Some studies reported that ginger was effective in prevention or treatment of post-surgical nausea and vomiting; however,
there are controversies. In addition, no study compared the effects of ginger on nausea and vomiting after open and laparoscopic
nephrectomies.
Objectives: The current study aimed to compare the effect of ginger essence on nausea and vomiting after open versus laparoscopic
nephrectomies.
Patients and Methods: A randomized, placebo trial was conducted on two groups of patients, 50 open and 50 laparoscopic nephrectomy.
Half of the subjects in each group received ginger essence and the other half received placebo. Using a visual analogue scale the severity of
nausea was assessed every 15 minutes for the first two post-operative hours and the sixth hour. Frequency of vomiting was counted until
the sixth hour. The placebo subgroups were treated similarly. Descriptive statistics were employed. Chi-square and Fishers exact tests,
paired and independent samples t-test and repeated measure analysis of variance were used to analyze the data.
Results: Repeated measure analysis of variance showed that the type of surgery and the type of intervention as factors had significant
effects on the nausea severity scores in the nine successive measurements (P < 0.001). In the first two post-operative hours, the mean
vomiting episodes was 2.92 0.70 in the subjects who underwent open surgery and received placebo while it was 0.16 0.37 in patients
with the same surgery but receiving ginger essence (P = 0.001). The mean vomiting episodes was 6.0 1.33 in the subjects who underwent
laparoscopic surgery and received placebo while it was 1.39 0.78 in patients with the same surgery but receiving ginger essence (P =
0.001).
Conclusions: Using ginger essence was effective in reducing nausea and vomiting not only in the subjects who underwent open
nephrectomy but also in the subjects of laparoscopic nephrectomy. Using ginger essence is suggested as a complementary remedy to
prevent and treat post-operative nausea and vomiting in patients with nephrectomy.
Keywords: Ginger; Laparoscopy; Nausea; Nephrectomy; Surgery; Vomiting

1. Background
Nausea and vomiting are the second most common
post-operative complications. The incidence of these
complications are about 20% - 30% (1). Post-operative
nausea and vomiting (PONV) is not only discomforting,
but also may result in serious aftermaths such as dehydration, electrolyte disturbances, aspiration, surgical
sutures dehiscence, esophageal rupture, subcutaneous
emphysema and pneumothorax that in turn would delay
patients recovery and hospital discharge (1). PONV is especially more prevalent after laparoscopic surgeries and
40% to 70% of the patients experience it (2). Therefore, it
is necessary to take appropriate measures to prevent and
treat the complications (2). Regional anesthesia, some
special anesthetic agents such as propofol, and antiemetic drugs are commonly used to prevent PONV (2). Side
effects of the drugs used for PONV are also a problem.
Metoclopramide and droperidol may result in drowsi-

ness and extra pyramidal symptoms. Moreover, metoclopramide may cause headache and diarrhea. Ondansetron
is also associated with headache, diarrhea, and transient
increase in hepatic transaminase level (3). To prevent or
decrease such side effects, alternative remedies might be
used instead of these medications. Ginger is a herb (4, 5)
native to Southeast Asia and is now cultivated in all tropical and subtropical regions (6). Ginger is effective to treat
nausea and vomiting and no significant side effects are
reported on it (6). Ginger has a swollen underground
rhizome, which contains some active ingredients such
as 6-shagoal and galanolacton that block serotonin receptors. Galanolacton also inserts an antiemetic effect
through a competitive antagonist effect on HT5 receptors
in the ileum (7). Some studies demonstrated the positive
effect of ginger products on the treatment of nausea
and vomiting (8). Ozgoli et al. (9) and Saberi et al. (10)

Copyright 2015, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial
usages, provided the original work is properly cited.

Hosseini FS et al.
reported that ginger capsule decreased the intensity of
pregnancy-induced nausea and vomiting (PINV). A recent
study also compared the effect of ginger and vitamin B6
on the treatment of PINV, and reported that ginger capsule was more effective than vitamin B6 (11). Moreover,
Ebrahimi et al. (12) and Ghanbari et al. (13) have reported
that ginger reduced chemotherapy induced nausea and
vomiting. Apariman et al. (14) also reported that ginger
was effective in prevention of nausea and vomiting after
gynecological laparoscopy. Also, Montazeri showed that
ginger was effective in reducing nausea and vomiting
after orthopedic, abdominal, urinary, reproductive, and
eye, nose and throat surgeries (15). However, Eberhart et
al. (16), and Vousooghian and Amini (17) reported that ginger was effective in preventing or treating PONV neither
after laparoscopic nor after open gynecological surgeries.
Modares et al. (18) also compared the antiemetic effects of
ginger and chamomile capsules on pregnancy induced
nausea and vomiting and reported that chamomile was
more effective than ginger. Almost all previous studies
used ginger capsules. The only study that examined the
effect of ginger essential oil on post-operative nausea reported that ginger essence was more effective in reducing
nausea after gynecological and gastrointestinal surgeries
than isopropyl alcohol and normal saline (19).

2. Objectives
Given the high prevalence of PONV and the side effects of
medicinal treatments, and considering the controversies
on the effect of ginger on PONV, and also due to the fact
that patients are usually not permitted to eat by mouth in
the early post-operative hours; the current study aimed to
compare the effect of ginger essential oil on nausea and
vomiting after open versus laparoscopic nephrectomies.

3. Patients and Methods

This randomized, placebo-controlled, clinical trial was
conducted on 100 nephrectomy patients; 50 open and
50 laparoscopic nephrectomy. The study was conducted
from April to October 2014. Inclusion criteria were age
18 years old and above, ability to read and write in Farsi
language, no recognized olfactory, hearing and balance
problems, and no history of asthma, allergy, respiratory
diseases and motion sickness, Nil Per Os (NPO) for at least
eight hours, being at class II of American Society of Anesthesiologists, receiving no chemotherapic agent, aspirin, anticoagulants and calcium channel blockers in the
last 48 hours, receiving no antiemetic drug in the last 24
hours, having no addiction to alcohol or other substances and having no sensitivity to ginger. Exclusion criteria
were deciding to withdraw from the study, developing
any allergic reactions or intolerance to ginger, and also
developing acute hemodynamic instability during the
study. Eligible subjects were recruited sequentially and
then randomly assigned to two groups; therefore half
of the subjects in each type of surgery received ginger
2

essence and the other half received placebo. To prevent

the probable exposure of the subjects in the placebo
group to ginger aroma, an alternation method was used
to randomly assign patients to either the ginger essence
or the placebo group. Therefore, the first day of the study
was randomly assigned to the ginger essence through a
coin-tossing method. Then, the following days were assigned to the placebo or the ginger essence alternately.
Therefore, there were four subgroups of subjects (i.e.
open surgery + ginger essence; laparoscopy + ginger essence; open surgery + placebo; laparoscopy + placebo).
When the number of required subjects in each subgroup
was completed, sampling was continued till the other
subgroups reached the predetermined size (Figure 1).
The sample size was calculated based on a previous study
(18), in which 34% of the intervention group and 61% of
the control group experienced PONV. Therefore, it was estimated that each group needed 50 subjects with a type
one error of 0.05 and a power of 0.80. The severity of nausea was assessed using a Visual Analogue Scale (VAS). It
consisted of a 10 cm column with descriptors at each end
(10 = the most severe nausea experienced; 0 = the absence
of nausea). Subjects were asked to mark an X on the place
that corresponded with the severity of nausea they experienced. In the case of vomiting, frequency of vomiting
was counted until the sixth post-operative hour. After surgery, subjects were transferred to the recovery room. In
the open and laparoscopic nephrectomy subjects allocated to receive ginger essence, two drops of ginger essence
(purchased from Zardband Pharmaceutical Co. Tehran,
Iran) were applied on 5 5 cm gauze and attached to the
collar of the patients gown. Additional drops of ginger
essence were then reapplied every 30 minutes for two
subsequent hours. The severity of nausea was assessed every 15 minutes for the first two post-operative hours and
also at the end of the sixth post-operative hour. The frequency of true vomiting was also calculated during the
first two post-operation hours and also till the next four
hours. The two placebo subgroups were treated similarly
except that normal saline was used instead of ginger essence. If any of the patients had moderate to severe nausea and vomiting, it was reported to the attending physician and, if prescribed, antiemetic medication was used
and the name, dose, and frequency of administration
were recorded. All subjects were anesthetized using the
same anesthesia protocol (i.e. the anesthesia was induced
using fentanyl (1 /kg) and midazolam (2 mg) and then
was continued through isoflurane 1% and thiopental sodium (4 mg/kg). The anesthesia procedure and the medication used were precisely documented for all subjects.

3.1. Ethical Considerations

The study was approved by the Institutional Review
Board and Research Ethics Committee of Kashan University of Medical Sciences. Permissions were also obtained
from the authorities in the Labbafinejad Hospital, TehNurs Midwifery Stud. 2015;4(2):e28625

Hosseini FS et al.
ran, Iran. All of the participants were briefed on the study
aims without specifying the exact type of intervention
they may receive. They also were assured of the confidentiality of their personal information and all of them
signed a written informed consent before participation.

3.2. Data Analysis

Data analysis was performed using SPSS software version 11.5. Descriptive statistics (i.e. mean, standard deviation, frequency, and percentage) were calculated. Chisquare and Fishers exact tests were used to compare the
data in terms of nominal and categorical variables such
as gender and type of nephrectomy. Paired t-test was used
for within group comparisons of the quantitative variables. Independent samples t-test was used to compare
the mean of physiological parameters, medications used,
and vomiting episodes in the two groups. Repeated measure analysis of variance was used to evaluate the effect of
the intervention on nausea in the nine subsequent measurements. P value < 0.05 was considered as significant.

4. Results
Totally, 100 subjects including 65 males and 35 females
participated in the study. Fifty percent of subjects who
underwent each type of surgery received ginger essence
while the others received normal saline. No significant

Enrollment

differences were observed between the patients demographics neither in terms of the type of surgery nor in
terms of the type of intervention (i.e. receiving ginger
essence or normal saline) (Table 1). Moreover, no significant differences were observed between the patients
physiological and pharmacological parameters neither
in terms of the type of surgery nor in terms of the type
of intervention except that the amount of ondansetron
received, which was significantly higher in the patients
who received placebo in both types of the surgeries (Table 2). The repeated measure analysis of variance showed
that the type of surgery and the type of intervention as
factors had significant effects on the nausea severity
scores in the nine successive measurements (P < 0.001)
(Figure 2). In the first two post-operative hours, the mean
vomiting episodes was 2.92 0.70 in the subjects who
underwent open surgery and received placebo; while it
was 0.16 0.37 in the subjects with the same surgery type
but receiving ginger essence (P = 0.001). At the same time,
the mean vomiting episodes was 6.0 1.33 in the subjects
who underwent laparoscopic surgery and received placebo while it was 1.39 0.78 in the subjects with the same
surgery but received ginger essence (P = 0.001). Although
the mean vomiting episodes significantly decreased in
all the groups in the next four post-operative hours, the
mean decreases were significantly evident in the subjects
who received ginger essence (P < 0.001) (Table 3).

Assessed for eligibility, n =340

Excluded, n = 240
Did not meet inclusion criteria, n = 230
Ref used to participate, n = 5
Other reasons, n = 5

Laparoscopic Nephrectomy n =50

Open Nephrectomy n =50

Randomized allocation
(n= 100 )
Ginger essence
n =25

Normal saline
n =25

Received treatment
n =25

Received treatment
n =25

Ginger essence
n =25

Normal saline
n =25

Received treatment
n =25

Received treatment
n =25

Analysed (n= 25)

Analysed (n= 25)

Follow-Up

Analysis
Analysed (n= 25)

Analysed (n= 25)

Figure 1. Consort Flow Diagram

Nurs Midwifery Stud. 2015;4(2):e28625

Hosseini FS et al.
Table 1. Demographic Characteristicsof the Study Participants (n=50) a
Variables

Open Nephrectomy
Normal Saline

Ginger Essence

P value b

Gender

Laparoscopic Nephrectomy
Normal Saline

Ginger Essence

0.34

Female

13 (52)

8 (32)

5 (20)

9 (36)

Male

12 (48)

17 (68)

20 (80)

16 (46)

Single

6 (24)

7 (28)

6 (24)

3 (12)

Married

19 (76)

18 (72)

19 (76)

22 (88)

6 (24)

7 (28)

19 (76)

18 (72)

13 (52)

12 (48)

12 (48)

13 (52)

Marital status

0.7

Education level

0.46

0.06

Primary school

14 (56)

20 (80)

Secondary school and higher

11 (44)

5 (20)

Employment

0.74

0.05

Jobless

15 (60)

22 (88)

Employed

10 (40)

3 (12)

Reason for nephrectomy

Donation

P Value b

0.15

0.77

> 0.99

0.72

16 (64)

13 (52)

Tumor

19 (76)

19 (76)

6 (24)

9 (36)

Non-functional kidney

6 (24)

6 (24)

3 (12)

3 (12)

a Data are presented as No. (%).

b Chi-square test.

Table 2. The Mean and Standard Deviation of Physiological and Pharmacological Parameters in the Intervention and the Placebo
Groups a
Variables

Open Nephrectomy

Laparoscopic Nephrectomy

Normal Saline

Ginger Essence

P Value

Normal Saline

Ginger Essence

Age, y

53.24 15.41

57.2 14.83

0.35

34.37 14.15

41.22 14.7

0.1

Body mass index, kg/m2

25.35 5.26

25.42 4.24

0.95

25.61 4.28

25.66 3.73

0.96

Systolic blood pressure, mmHg

139.64 21.16

130.20 21.14

0.12

138.03 18.87

131.30 14.17

0.16

Diastolic blood pressure, mmHg

80.56 17.83

72.36 20.93

0.14

76.92 20.75

78.21 21.71

0.78

Heart rate, per min.

80.16 9.20

81.96 9.88

0.5

81.26 6.71

81.70 7.95

0.83

Respiratory rate, per min

14.49 4.69

13.32 1.28

0.23

13.93 1.70

13.87 1.66

0.9

Body temperature, C

36.18 3.79

36.90 0.22

0.35

36.91 0.32

39.1 0.34

0.28
0.34

Times anesthesia, h

P Value

3.96 0.67

3.07 0.63

0.56

3.99 0.88

3.75 0.86

Fluid intake on operative room, mL

3400 1645.70

2980 1065.36

0.28

3870.37 986.37

3717.39 986.57

0.57

Fluid intake on recovery room, mL

524 250.46

456 104.40

0.21

537.04 237.2

565.22 228.84

0.67

Medication received
Oxygen, L/min

4.96 1.27

4.72 1.33

0.51

4.96 1.37

4.69 1.10

0.45

Isofluran

0.94 0.12

0.91 0.04

0.11

0.92 0.24

1.0 0.001

0.13

Thiopental sodium, mg

252 106.53

290.80 80.04

0.15

305.56 69.79

319.57 41.93

0.4

2.46 1.13

2.08 0.27

0.11

2.19 1.07

2.30 0.7

0.65

Midazolam, mg

1.38 0.36

1.36 0.56

0.9

1.48 0.84

1.39 0.49

0.65

Ondansetron, mg

2.38 0.77

00

< 0.001

4.74 1.76

2.0 0.81

< 0.001

Fentanil, /kg

a Data are presented as mean SD.

Table 3. The Mean and Standard Deviation of Vomiting Episodes in the Two and Four Post-operative Hours in the Study Groups a
Numbers of vomiting episodes

Laparoscopic Nephrectomy

Open Nephrectomy

Ginger Essence

Normal Saline

P value b

In the recovery room

1.39 0.78

6.0 1.33

< 0.001

Third hour till the end of sixth hour

0.26 0.44

3.22 1.05

< 0.001

00

1.40 0.64

< 0.001

< 0.001

< 0.001

< 0.001

< 0.001

P Value

Ginger Essence

Normal Saline

P value b

0.16 0.37

2.92 0.70

< 0.001

a Data are presented as Mean SD.

b Independent Samples Test.

Nurs Midwifery Stud. 2015;4(2):e28625

Hosseini FS et al.

Lapara+Ginger
Lapara+Saline
Open+Saline
Open+Ginger

na
us
na ea 1
us
e
na a 2
us
e
na a 3
us
e
na a 4
us
e
na a 5
us
e
na a 6
us
e
na
na a 7
us
us
ea
ea
En
8
d
of
6
th
h.

9
8
7
6
5
4
3
2
1
0

Figure 2. The Changes in Nausea Mean Scores in Nine Successive Measurements in the Study Subgroups

5. Discussion
The current study compared the effects of inhaling the
ginger essence on PONV after laparoscopic and open
nephrectomy surgeries. Results of the present study
showed that in comparison with the placebo, ginger essence could effectively reduce the mean nausea severity
in patients who underwent either open or laparoscopic
nephrectomy. Moreover, the mean post-operative vomiting episodes were significantly lower in the subjects who
received ginger essence than in the ones who received
normal saline as placebo. The beneficial effect of ginger
essence on PONV was also visible in the amount of antiemetic medication used for the participants; so that, the
mean dose of ondansetron used was significantly lower
in the subjects who received ginger essence than ones
who did not. In addition, the beneficial effect of ginger
was considerably visible in the subjects with open nephrectomy. Thus, the severity of vomiting was more
in the subjects who underwent laparoscopic nephrectomy with placebo than in the other groups. Then, the
dose of antiemetic medication used in this group (i.e.
laparoscopic nephrectomy with placebo) was considerably more than the other groups. Results of the present
study were consistent with some of the previous studies.
Vousooghian et al. (17) investigated the effect of ginger
on nausea and vomiting after gynecological surgeries
and confirmed that ginger was significantly effective
on reducing post-operative nausea though it could not
significantly affect post-surgical vomiting (17). Phillips
et al. (20) also compared the antiemetic effects of ginger and metoclopramide in females who underwent day
case surgeries. They reported that ginger was as effective as metoclopramide in reducing PONV. Moreover, the
amount of antiemetic medication used was significantly
lower in the group who received ginger. A recent metaanalysis also confirmed the beneficial effects of ginger
on prevention of PONV either in open or laparoscopic
surgeries (21). In contrast to the current study results,
Montazeri et al. (15) reported that though ginger could
Nurs Midwifery Stud. 2015;4(2):e28625

reduce the nausea in the first two post-operative hours,

this effect significantly diminished afterwards. Moreover, ginger showed no effect on post-operative vomiting
in comparison with the control group. Similarly, Apariman et al. (14) reported that ginger exerts its antiemetic
effects mostly in the first two hours after surgery and its
effects on PONV would reduce afterwards. This phenomenon was attributed to the fact that patients are usually
transported out of the recovery room approximately after two hours. The resultant movements may stimulate
the mechanism of nausea and vomiting. Therefore, antiemetic effects of ginger may be reduced at this time.
Eberhart et al. (16) and Morin et al. (22) conducted two
reviews on the effect of ginger on prevention and treatment of PONV and concluded that ginger has no positive
effect on prevention or treatment of PONV. Eberhart et al.
(16) also reported the same finding after reviewing the
studies that have been used ginger to prevent PONV in
laparoscopic gynecological surgeries. However, they attributed this finding to the low dose of the ginger used
in the reviewed studies (16). On the other hand, Arfeen et
al. (23) and Visalyaputra et al. (24) reported that increasing the dose of ginger resulted in a slight increase in the
severity of nausea after laparoscopic surgeries. The inconsistencies in the studies may not only be attributed
to the amount and the frequency of the ginger used, but
also to the type of the surgeries that ginger was administered in. As was the case in the present study, ginger may
be more effective if can be used through inhalation (i.e.
the ginger essence). In addition, it seems that it would
be more effective if used as small frequent doses and this
type of application was simply possible when its essence
was used. Perhaps, the frequent use of the ginger essence
in the present study helped the dosage of the remedy
reach its therapeutic effect. On the other hand, as it was
evident in the present study, ginger essence was more
effective in the subjects who underwent open surgeries than the ones who tolerated a laparoscopic surgery.
Perhaps the CO2 used in laparoscopic surgeries and the
upward displacement of diaphragm in such operations
would delay the elimination of the anesthetics through
respiration, then PONV decreased more slightly in such
subjects. In conclusion, the present study showed that
using ginger essence was effective in reducing nausea
and vomiting not only in patient who underwent open
nephrectomy, but also in the ones who underwent laparoscopic nephrectomy. However, it seems that the therapeutic effects of ginger start with a delay of about 30
minutes. Due to the effectiveness of the intervention in
the current study, using ginger essence is suggested as
a complementary remedy to prevent and treat PONV in
patients with nephrectomy. However, the current study
was conducted on a small sample size and therefore further studies with larger sample sizes are suggested. It is
also recommend replicating the same study in patients
with cluster and diaphragmatic breathing patterns.
Moreover, since ginger essence is an aromatic material,
5

Hosseini FS et al.
blinding the patients and the evaluators was not possible in the current study and it was a limitation that
should be reminded.

Acknowledgements
Authors would like to profusely thank the Research
Council of Kashan University of Medical Sciences that
financially supported the study. Moreover, authors
hereby appreciate the study participants as well as the
administrators of Labbafinejad Hospital, Tehran, Iran,
who supported us throughout the study. This study was
registered at the Iranian Registry of Clinical Trials (no.
IRCT2014080218650N1).

Authors Contributions
Mohsen Adib-Hajbaghery is responsible for thestudy
conception, design, data analysis, supervision of
thestudy and preparation of the manuscript. Fatemeh
Sadat Hosseini participated in the study conception and
performed data collection.

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