Exploration of Non-Pharmacological Interventions in Reducing Patient Anxiety in the Operating Room: A Scoping Review
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Preoperative anxiety is a common problem that impacts surgical outcomes and patient well-being. Non-pharmacological interventions offer a safe alternative to managing anxiety without the side effects of medication. This scoping review aims to map the evidence related to non-pharmacological interventions in reducing patient anxiety in the operating room. Following the Arksey and O’Malley framework and the JBI guidelines, a search was conducted in databases such as PubMed and Scopus until August 2025, with inclusion criteria of primary and secondary studies on non-pharmacological interventions in preoperative patients. Data were extracted for variables such as intervention type, population, and effectiveness, and analyzed narratively and thematically. Of the 15 studies, interventions such as music therapy, virtual reality, clown therapy, aromatherapy, and pre-operative education were effective in reducing anxiety by 15-30% in children and adults, with additional benefits on patient satisfaction and physiological stability. Interactive interventions were more effective in children, while sensory therapy was superior in adults. Non-pharmacological interventions are a promising strategy for pre-operative anxiety management, with the need for further research in elderly and emergency surgery populations to strengthen clinical applications.
Agüero-Millan, B., Abajas-Bustillo, R., & Ortego-Maté, C. (2023). Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews. Journal of Clinical Nursing, 32(17–18), 6229–6242. https://doi.org/10.1111/jocn.16755
Ali, M. A., Khan, M. H., & Salim, B. (2025). Comparing Pharmacological and Nonpharmacological Interventions for Alleviating Preoperative Anxiety in Pediatric Surgical Patients: A Randomized Controlled Trial in Pakistan. Cureus, 17(4), 1–7. https://doi.org/10.7759/cureus.82502
Álvarez-García, C., & Yaban, Z. Ş. (2020). The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis. Complementary Therapies in Clinical Practice, 38, 101077. https://doi.org/10.1016/j.ctcp.2019.101077
Aranha, A. (2022). Hand and foot massage for preoperative anxiety in gynecological surgery. J Perianesth Nurs, 37(3), 321–327.
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice, 8(1), 19-32. https://doi.org/10.1080/1364557032000119616
Baghele, A., Dave, N., Dias, R., & Shah, H. (2019). Effect of preoperative education on anxiety in children undergoing day-care surgery. Indian Journal of Anaesthesia, 63(7), 565–570. https://doi.org/10.4103/ija.IJA_37_19
Chen, H., Zhang, J., Li, S., Zhang, H., & Wei, L. (2025). Non-pharmacological Interventions for Preoperative Anxiety in Children: A Systematic Review and Network Meta-Analysis. Journal of Clinical Nursing, 34(4), 1493–1507. https://doi.org/10.1111/jocn.17582
Dionigi, A., Sangiorgi, D., & Flangini, R. (2014). Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial. Journal of Health Psychology, 19(3), 369–380. https://doi.org/10.1177/1359105312471567
He, H.-G., Zhu, L., Chan, S. W. C., Klainin-Yobas, P., & Wang, W. (2015). The effectiveness of therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and postoperative pain in children undergoing elective surgery: a systematic review. Pain Management Nursing : Official Journal of the American Society of Pain Management Nurses, 16(3), 425–439. https://doi.org/10.1016/j.pmn.2014.08.011
Jayasree, B., & Thenmozhi, P. (2015). Effectiveness of Music Therapy on Pre-Operative Anxiety Among Patients Undergoing Cataract Surgery. International Journal of Multidisciplinary Educationalresearch, 4(8), 141–147.
Jlala, H. A., French, J. L., Foxall, G. L., Hardman, J. G., & Bedforth, N. M. (2010). Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. British journal of anaesthesia, 104(3), 369–374. https://doi.org/10.1093/bja/aeq002
Kisielewska, W., Kościółek, M., Kowalczyk, W., Mitura, B., Mitura, L., Rogula, S., Leszczyński, P. K., Antosik, K., & Mitura, K. (2025). Decreasing Preoperative Anxiety in Patients with Newly Available Multimodal Approaches—A Narrative Review. Journal of Clinical Medicine, 14(9), 1–19. https://doi.org/10.3390/jcm14092940
Li, Y., Peng, S., Xia, X., Yin, L., & Liao, L. (2025). Nonpharmacological interventions for decreasing anxiety during anesthesia induction in children: a systematic review and Bayesian network meta-analysis. BMC anesthesiology, 25(1), 1-15. https://doi.org/10.1186/s12871-025-03077-z
Liu, J., Reyes Serrano, T., Nguyen, T., Newcomer, C. A., Wagner, J. P., & Comulada, W. S. (2024). Evaluating the Feasibility and Acceptability of Surgery Prep, a Virtual Reality Perioperative Walkthrough Designed to Help Pediatric Patients Psychologically Prepare for Surgery. The Journal of Child Life: Psychosocial Theory and Practice, 5(2), 1–11. https://doi.org/10.55591/001c.126782
Modanloo, M., Halakou, S., Khoddam, H., Nikpeyma, N., & MojaverAghili, S. (2023). Non-pharmacological interventions for anxiety management in patients undergoing anesthesia (a way to preoperative caring): A narrative review. Preventive Care In Nursing and Midwifery Journal, 13(4), 71–86.
Pestana-Santos, M., Santos, M. R., Cardoso, D., & Lomba, L. (2019). Non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents: a scoping review protocol. JBI Database of Systematic Reviews and Implementation Reports, 17(9), 1883–1893. https://doi.org/10.11124/JBISRIR-2017-003925
Peters, M. D., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. JBI Evidence Implementation, 13(3), 141-146. https://doi.org/10.1097/XEB.0000000000000050
Santiago, M. G., Benítez, J. R., López, L. L., Otero, A. N., Martos, I. C., Valenza, M. C., & Ciuró, A. H. (2025). Effects of non-drug interventions to alleviate anxiety in children undergoing surgery: a systematic review and meta-analysis. Journal of Hospital Management and Health Policy, 9, 1–16. https://doi.org/10.21037/jhmhp-24-99
Sarialioğlu, A., Kurudirek, F., & Oluç, T. (2023). The effect of storybook reading on children’s preoperative fear and anxiety levels: A randomized controlled study. Child: Care, Health and Development, 49(5), 906–913. https://doi.org/10.1111/cch.13100
Tailor, M., Illescas, A., Zhong, H., Long, W. J., Lin, Y., & Umeh, U. O. (2025). Aromatherapy for Anxiety and Pain After Total Knee Replacement: A Pilot Randomized Controlled Trial. Anesthesia & Analgesia. Retrieved from: https://journals.lww.com/anesthesia-analgesia/fulltext/9900/aromatherapy_for_anxiety_and_pain_after_total_knee.1434.aspx
Tanja-Dijkstra, K., Pahl, S., White, M. P., Andrade, J., May, J., Stone, R. J., Bruce, M., Mills, I., Auvray, M., Gabe, R., & Moles, D. R. (2014). Can virtual nature improve patient experiences and memories of dental treatment? A study protocol for a randomized controlled trial. Trials, 15, 90. https://doi.org/10.1186/1745-6215-15-90
Tola, Y. O., Chow, K. M., & Liang, W. (2021). Effects of non‐pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review. Journal of clinical nursing, 30(23-24), 3369-3384. https://doi.org/10.1111/jocn.15827
Toseeb, U., Brage, S., Corder, K., Dunn, V. J., Jones, P. B., Owens, M., ... & Goodyer, I. M. (2014). Exercise and depressive symptoms in adolescents: a longitudinal cohort study. JAMA pediatrics, 168(12), 1093-1100. https://doi.org/10.1001/jamapediatrics.2014.1794
Tricco, A. C. (1967). Prisma extension for scoping reviews (prisma-scr): Checklist and explanation. Angew Chemie Int Ed, 6(11), 951.
Ugras, G. A., Kanat, C., Yaman, Z., Yilmaz, M., & Turkmenoglu, M. O. (2023). The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial. Journal of Perianesthesia Nursing : Official Journal of the American Society of PeriAnesthesia Nurses, 38(2), 277–283. https://doi.org/10.1016/j.jopan.2022.07.005
Vagnoli, L., Caprilli, S., Robiglio, A., & Messeri, A. (2005). Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics, 116(4), e563-e567. https://doi.org/10.1542/peds.2005-0466
Wang, R., Huang, X., Wang, Y., & Akbari, M. (2022). Non-pharmacologic approaches in preoperative anxiety, a comprehensive review. Frontiers in public health, 10, 854673. https://doi.org/10.3389/fpubh.2022.854673
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