Effectiveness of Deep Breathing Relaxation Technique in Reducing Postoperative Nausea and Vomiting Among Patients Receiving Spinal Anesthesia: A One-Group Pretest–Posttest Study

Najwa Zajida  Latifah; Joko  Murdiyanto; Aisyah Nur  Azizah

doi:10.66763/gjmsn.v1i2.38

Authors

Najwa Zajida Latifah Universitas ‘Aisyiyah Yogyakarta Author
Joko Murdiyanto Universitas ‘Aisyiyah Yogyakarta Author
Aisyah Nur Azizah Universitas ‘Aisyiyah Yogyakarta Author

DOI:

https://doi.org/10.66763/gjmsn.v1i2.38

Keywords:

Deep breathing relaxation, Postoperative nausea And Vomiting, Ponv, Spinal anesthesia references

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common complication after surgery, including among patients receiving spinal anesthesia. PONV may reduce patient comfort, delay recovery, and increase the need for additional postoperative management. Deep breathing relaxation is a simple nonpharmacological intervention that may help reduce nausea and vomiting by promoting relaxation and parasympathetic activity.
Objectives: This study aimed to evaluate the effectiveness of deep breathing relaxation technique in reducing PONV among postoperative patients receiving spinal anesthesia.
Methods: This study used a pre-experimental design with a one-group pretest–posttest approach. A total of 60 postoperative patients receiving spinal anesthesia were selected using purposive sampling. PONV severity was measured before and after the intervention using the Rhodes Index of Nausea, Vomiting, and Retching (RINVR). Data were analyzed using the Wilcoxon signed-rank test.
Results: Before the intervention, most respondents experienced moderate PONV (56.7%) and severe PONV (40.0%). After deep breathing relaxation, most respondents experienced mild PONV (91.7%), while 8.3% experienced moderate PONV. The Wilcoxon test showed a significant reduction in PONV severity after the intervention (Z = -6.915; p < 0.001).
Conclusions: Deep breathing relaxation was effective in reducing PONV among postoperative patients receiving spinal anesthesia. This technique may be used as a safe, simple, and feasible supportive intervention in postoperative care.

References

Amirshahi, M., Behnamfar, N., Badakhsh, M., Rafiemanesh, H., Keikhaie, K. R., Sheyback, M., & Sari, M. (2020). Prevalence of postoperative nausea and vomiting: A systematic review and meta-analysis. Saudi Journal of Anaesthesia, 14(1), 48–56. https://doi.org/10.4103/sja.SJA_401_19

Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895

Bentley, T. G. K., D’Andrea-Penna, G., Rakic, M., Arce, N., LaFaille, M., Berman, R., Cooley, K., & Sprimont, P. (2023). Breathing practices for stress and anxiety reduction: Conceptual framework of implementation guidelines based on a systematic review of the published literature. Brain Sciences, 13(12), 1612. https://doi.org/10.3390/brainsci13121612

Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13, 432. https://doi.org/10.1038/s41598-022-27247-y

Gan, T. J., Belani, K. G., Bergese, S., Chung, F., Diemunsch, P., Habib, A. S., Jin, Z., Kovac, A. L., Meyer, T. A., Urman, R. D., Apfel, C. C., Ayad, S., Beagley, L., Candiotti, K., Englesakis, M., Hedrick, T. L., Kranke, P., Lee, S., Lipman, D., Minkowitz, H. S., Morton, J., Philip, B. K., & Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting Expert Panel. (2020). Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 131(2), 411–448. https://doi.org/10.1213/ANE.0000000000004833

Gholamrezaei, A., Van Diest, I., Aziz, Q., Vlaeyen, J. W. S., & Van Oudenhove, L. (2021). Psychophysiological responses to various slow, deep breathing techniques. Psychophysiology, 58(2), e13712. https://doi.org/10.1111/psyp.13712

Gress, K., Urits, I., Viswanath, O., & Urman, R. D. (2020). Clinical and economic burden of postoperative nausea and vomiting: Analysis of existing cost data. Best Practice & Research Clinical Anaesthesiology, 34(4), 681–686. https://doi.org/10.1016/j.bpa.2020.07.003

Huh, H. (2023). Postoperative nausea and vomiting in spinal anesthesia. Korean Journal of Anesthesiology, 76(2), 87–88. https://doi.org/10.4097/kja.23157

Ibrahim, H. A. N., Al-Sebaee, H., & El-Deen, D. S. (2020). Effect of diaphragmatic breathing exercise on postoperative nausea, vomiting, and retching among orthopedic surgery patients. Egyptian Nursing Journal, 17(1), 47–53. https://doi.org/10.4103/enj.enj_19_20

Jin, Z., Gan, T. J., & Bergese, S. D. (2020). Prevention and treatment of postoperative nausea and vomiting (PONV): A review of current recommendations and emerging therapies. Therapeutics and Clinical Risk Management, 16, 1305–1317. https://doi.org/10.2147/TCRM.S256234

Joseph, A. E., Moman, R. N., Barman, R. A., Kleppel, D. J., Eberhart, N. D., Gerberi, D. J., Murad, M. H., & Hooten, W. M. (2022). Effects of slow deep breathing on acute clinical pain in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Evidence-Based Integrative Medicine, 27, 2515690X221078006. https://doi.org/10.1177/2515690X221078006

Kilinç, T., & Karaman Özlü, Z. (2024). Effect of acupressure application on patients’ nausea, vomiting, pain, and sleep quality after laparoscopic cholecystectomy: A randomized placebo-controlled study. Explore, 20(1), 44–52. https://doi.org/10.1016/j.explore.2022.11.004

Kovac, A. L. (2025). Pathophysiology and risk factors for postoperative nausea and vomiting in adults and children. BJA Education, 25(6), 234–239. https://doi.org/10.1016/j.bjae.2025.02.003

Moraitis, A., Hultin, M., & Walldén, J. (2020). Risk of postoperative nausea and vomiting in hip and knee arthroplasty: A prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiology, 20, 242. https://doi.org/10.1186/s12871-020-01154-z

Noble, D. J., & Hochman, S. (2019). Hypothesis: Pulmonary afferent activity patterns during slow, deep breathing contribute to the neural induction of physiological relaxation. Frontiers in Physiology, 10, 1176. https://doi.org/10.3389/fphys.2019.01176

Rajan, N., & Joshi, G. P. (2021). Management of postoperative nausea and vomiting in adults: Current controversies. Current Opinion in Anaesthesiology, 34(6), 695–702. https://doi.org/10.1097/ACO.0000000000001063

Schlesinger, T., Meybohm, P., & Kranke, P. (2023). Postoperative nausea and vomiting: Risk factors, prediction tools, and algorithms. Current Opinion in Anaesthesiology, 36(1), 117–123. https://doi.org/10.1097/ACO.0000000000001220

Stoops, S., & Kovac, A. (2020). New insights into the pathophysiology and risk factors for PONV. Best Practice & Research Clinical Anaesthesiology, 34(4), 667–679. https://doi.org/10.1016/j.bpa.2020.06.001

Tsai, S.-J., Lu, Y.-Y., Wong, C.-S., Huang, T.-H., & Lee, S.-O. (2025). Effects of auricular acupressure on postoperative nausea and vomiting in patients with gynecological laparoscopic surgery: A randomized controlled trial. Journal of PeriAnesthesia Nursing, 40(3), 647–652. https://doi.org/10.1016/j.jopan.2024.08.005

Wang, J.-Y., Huang, H.-Y., Chu, W.-O., Peng, T.-R., Lee, M.-C., Chen, S.-M., & Lee, J.-A. (2024). Aromatherapy for the prevention of postoperative nausea and vomiting: A systematic review and meta-analysis. Tzu Chi Medical Journal, 36(3), 330–339. https://doi.org/10.4103/tcmj.tcmj_240_23

Weiser, T. G., Haynes, A. B., Molina, G., Lipsitz, S. R., Esquivel, M. M., Uribe-Leitz, T., Fu, R., Azad, T., Chao, T. E., Berry, W. R., & Gawande, A. A. (2016). Size and distribution of the global volume of surgery in 2012. Bulletin of the World Health Organization, 94(3), 201–209F. https://doi.org/10.2471/BLT.15.159293

Zhong, W., Shahbaz, O., Teskey, G., Beever, A., Kachour, N., Venketaraman, V., & Darmani, N. A. (2021). Mechanisms of nausea and vomiting: Current knowledge and recent advances in intracellular emetic signaling systems. International Journal of Molecular Sciences, 22(11), 5797. https://doi.org/10.3390/ijms22115797