Journal of PeriAnesthesia Nursing xxx (xxxx) xxx

Contents lists available at ScienceDirect

Journal of PeriAnesthesia Nursing

journal homepage: www.jopan.org

Research

Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm

Randomized Controlled Clinical Trial on Phacoemulsification
Candidates
Moloud Farmahini Farahani, MSc a, Masoomeh Noruzi Zamenjani, MSc a,
Morteza Nasiri, MSc b, c, Soheila Shamsikhani, MSc a, Zahra Purfarzad, PhD d,
Mehdi Harorani, MSc a, *
a
Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
b
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
c
Department of Operating Room Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
d
Department of Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

a b s t r a c t
Keywords: Purpose: The present study aimed to compare the effects of foot and hand massage on preoperative anxiety.
anxiety Design: Three-arm randomized, nonblinded, placebo-controlled, parallel group trial.
cataract extraction
Methods: This study was conducted on 90 female candidates waiting for phacoemulsification cataract
massage
preoperative care
surgery in Arak Amirkabir Hospital, Iran. Patients were consecutively selected and randomly divided into
vital signs three groups of hand (n ¼ 30), foot (n ¼ 30), and placebo (n ¼ 30), using a random number generator
software program. In each group, massage was performed 5 minutes for each hand or foot in the surgical
waiting room about 10 minutes before surgery. Anxiety was measured before and after the intervention
by visual analog scale and also assessing physiological indicators (heart rate, respiratory rate, systolic and
diastolic blood pressures).
Findings: All the 90 patients completed the study and were included in the final analysis. Both hand and
foot massage resulted in a significant decrease compared with placebo massage in anxiety and heart rate.
However, no significant difference was found between hand and foot massage in any of the measured
parameters. In the foot group and hand group, a significant reduction was observed in heart rate and
anxiety after the intervention, whereas the anxiety increased significantly in the placebo group after the
intervention. Moreover, systolic blood pressure in the foot group and the respiratory rate in the hand
group significantly decreased after the intervention.
Conclusions: Application of hand or foot massage seems to be effective in managing anxiety in patients
waiting for phacoemulsification cataract surgery.
© 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved.

Preoperative anxiety is an unpleasant and common reaction when the patient enters the surgical waiting room.2 In addition to
experienced by patients scheduled for surgery.1 It begins as soon as psychological responses, preoperative anxiety can stimulate activ-
the surgery is planned and peaks on the day of surgery, especially ity of the sympathetic nervous system and the vasovagal reflex,

confirmed that this work has a secondary finding that was not discussed in the first
Conflicts of interest: The authors disclosed that a part of this article was previously
Persian article.
published in Persian, comparing two groups of hand massage and control (Farm-
Funding: This study was supported by Arak University of Medical Sciences, Arak, Iran
ahini Farahani M, Shamsikhani S, Norouzi Zamenjani M, Pourfarzad Z, Qolami M;
(Registration No. 969).
The effect of hand massage on anxiety and physiological indicators before surgery.
This trial was registered in the Iranian Registry of Clinical Trials (Registration No.
Complement Med J. 2017; 7(1):1758-66). Considering the novelty of the research
IRCT2014080910713N4).
and its international importance, we decided to combine the rest of the work with
* Address correspondence to Mehdi Harorani, Department of Nursing, School of
our previous findings in a full international article, comparing three groups of hand
Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran.
massage, foot massage, and control. For this purpose, a letter of permission was
E-mail address: m.harorani@yahoo.com (M. Harorani).
obtained from the Complement Med J to reuse the published findings. Hereby, we

https://doi.org/10.1016/j.jopan.2019.10.010
1089-9472/© 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved.

Please cite this article as: Farmahini Farahani M et al., Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized
Controlled Clinical Trial on Phacoemulsification Candidates, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2019.10.010
2 M. Farmahini Farahani et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx
leading to physiological reactions such as tachycardia, hyperten-
sion, hyperthermia, muscle tension, and sweating.3,4 Moreover, it
can lead to elevated cortisol levels, which is associated with
reduced immune responses, a longer wound healing time,
increased infection rates, and electrolyte imbalances.3,5 Accord-
ingly, there is a great need for an appropriate method to prevent or
alleviate preoperative anxiety.
Massage is a simple, nonetime-consuming, and noninvasive
intervention that serves as a complementary and alternative method
for managing patients' surgical anxiety.6 Recent trials have confirmed
the effects of hand massage on preoperative anxiety of patients
waiting for different types of surgeries.7-9 However, there is limited
evidence regarding the anxiolytic properties of foot massage in the
preoperative setting,10 and most studies merely focus on postoperative

2
 
Z1a2 þ Z1b d21 þ d22
n¼
ðm1  m2 Þ2
anxiety.11-20 Moreover, trials on the effects of both hand and foot
massage mostly were conducted in a postoperative setting,15,16,19,21
and no data are available for the preoperative phase. To the best of
our knowledge, no study has compared the effect of hand and foot
massage on preoperative anxiety of candidates waiting for cataract
surgery. However, the effectiveness of only hand massage in reducing
anxiety was established previously in these candidates.22,23 For this
reason, as well as the importance of reducing preoperative anxiety and
the nurses' role in complementary and alternative interventions, we
compared the effect of foot and hand massage on preoperative anxiety
in phacoemulsification cataract surgery candidates.
Materials and Methods
Ethical Confirmation
The study was approved by the local Ethics Committee of Arak
University of Medical Sciences (Registration no.: 8-152-92). All
admitted patients were given a brief explanation about study objec-
tives, and also all were informed regarding the procedures as early as
possible after their admission to the unit. Moreover, all participants
signed a written informed consent before their enrollment. Since the
current study is secondery analysis of a previously published trial, a
letter of permission was obtained to reuse the published findings.
Study Design
This is secondary analysis of a three-arm randomized, non-
blinded, placebo-controlled, parallel group clinical trial.24 The study
was registered in the Iranian Registry of Clinical Trials (Registration
no.: IRCT2014080910713N4).
Sample
The study was conducted on women who were candidates for
phacoemulsification cataract surgery using local anesthesia in the
ophthalmology unit of Arak Amirkabir Hospital, Iran. The only in-
clusion criterion was the ability to communicate verbally in Persian.
Candidates were excluded if they (1) had received tranquilizers,
sedatives, or antianxiety medications within the last 48 hours; (2)
had received massage or other relaxation methods (ie, music
Please cite this article as: Farmahini Farahani M et al., Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized
Controlled Clinical Trial on Phacoemulsification Candidates, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2019.10.010
therapy) in the past week; (3) had a history of surgery, psycho-
logical, or anxiety disorders and diseases that increase epinephrine
and norepinephrine; and (4) had erythema, edema, fractures, pain,
and abnormalities in hands or feet as well as other conditions
affecting their hand or feet (ie, phlebitis, diabetes mellitus, neuro-
logical disorder). Also, patients were excluded if their surgery was
canceled.
The sample size was calculated based on a previous study,7
indicating a significant difference between preoperative anxiety
of hand massage group (1.31 ± 1.69) and control group
(2.89 ± 2.58), using visual analog scale (0-10). The sample size
was estimated at 30 participants in each group, considering the
following formula at a confidence level of 95% and power of
0.80.
h i
ð1:96 þ 0:84 Þ2 ð1:69Þ2 þ ð2:58Þ2
¼ ¼ 29:88y30
ð1:31  2:89 Þ2
Randomization and Blinding
Candidates were sequentially selected from April 2014 to March
2015, and those who met the inclusion criteria were randomly
divided into three groups of foot, hand, and placebo massage, using
a random number generator software program. For this purpose, a
random number was allocated for each newly accepted patient. If
this number was 1 to 30, 31 to 60, and 61 to 90, then patients were
allocated in hand, foot, and placebo massage, respectively.
Randomization was conducted by the main researcher, and all the
data were kept confidential until the end of study.
Measures
Demographic and clinical information were collected 1 day before
the surgery using the patients' clinical records and interviews. To
measure anxiety, both psychological and physiological indices were
considered. The visual analog scale was used to evaluate the psy-
chological anxiety of patients. This self-report scale consists of a
horizontal line with the descriptors “no anxiety” at the left side
(score: 0) and “severe anxiety” at the right side (score: 10).25 The
patients were asked to rate the level of their anxiety from 0 to 10.
This standard tool has been used among surgery candidates as a
reliable and valid scale.26,27
Physiological indicators of anxiety including heart rate (HR),
respiratory rate (RR), systolic blood pressure (SBP), and diastolic
blood pressure (DBP) were recorded on a data-recording sheet. SBP
and DBP were measured by using a calibrated mercury sphygmo-
manometer and stethoscope (Omron Corporation, Germany). RR
was measured by counting the number of respirations, and HR was
measured by counting the radial pulse for 60 seconds. All the out-
comes were recorded about 15 minutes after entering the surgical
waiting room and also 5 minutes after the intervention by a blinded
nursing assistant, who was not involved in the intervention.
Procedures
Patients in the three groups received the same preoperative care.
All patients were scheduled to be operated on by the same surgeon,
using the same technique, between 9 a.m. and 2 p.m. Immediately
after pretest measurements and about 10 minutes before the surgery,
 M. Farmahini Farahani et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx 3

Table 1
Steps of Foot and Hand Massage Performed in the Present Study

Part Steps (in Sequence)

Hand 1. A gentle and rhythmic pressure was applied by finger tips on the thumb pad, index finger pad, the webbing between each of the patient's fingers, and to the
fleshy part of the base of the patient's thumb on the palmar surface.
2. A squeezing pressure, similar to wringing and twisting, was applied by thumb pad and index finger pad on each of the patient's fingers and the thumb from the
base to the finger tip.
3. While supporting the patient's palm with the palm of one hand, the back of the patient's hand and fingers were rubbed in a circular way using the palm of other
hand. Also, a gentle milking movement was applied to the ulnar and radial side of the patient's hand.
Foot 1. While supporting the patient's ankle with one hand, a gentle and rhythmic pressure was applied on the sole of the foot by finger tips of the other hand, starting
from under the metatarsophalangeal joints and descending toward the heel. The movement continued around the heel and it was applied toward the level of the
metatarsophalangeal joints.
2. While supporting the patient's ankle with the palm of one hand, a squeezing pressure was applied to the lateral side of the foot with thumb pad and index finger
pad of the other hand starting on the edge of the little toe and moving toward the heel.
3. While supporting the patient's ankle with the palm of one hand, the foot dorsum was rubbed in a circular way by the palm of the other hand from the proximal
metatarsophalangeal joints toward the ankle. When reaching the ankle, the massage was continued above the medial malleolus.

each patient received either hand massage, foot massage, or placebo
massage by a qualified nursing assistant, who had successfully
completed a 12-hour workshop on “therapeutic applications of classic
massage” held by the Iranian Scientific Association of Medical Edu-
cation. The patients in the placebo group were placed in the same
environment as the two other groups, while they received hand-
holding as placebo massage. Indeed, patients received real massage in
hand massage and foot massage groups, whereas in the placebo
group, patients’ hands were rubbed without any pressure. Real mas-
sages were applied on different parts of hands or feet without focusing
on a determined point using petrissage, kneading, and friction tech-
niques (Table 1).
All massages were performed in a private room, and none of the
patients saw each other during the therapy session. To implement
massage, first the patients' extremities were cleaned with a
disposable wet-nap, then the patients were placed on a bed in su-
pine position and the nurse stood at the bottom of the bed, facing the
patients. During the foot massage, only the foot area was uncovered
to preserve the patient's privacy. Also, each foot was supported by a
pillow placed underneath it to facilitate the massage application. In
the three groups, first one foot or hand was massaged for 5 minutes,
and then the same procedure was performed on the other foot or
hand. Hence, the total massage time was 10 minutes for each patient.
Although there is no specific evidence of how long the application of
massage should last, we considered 5 minutes for each foot or hand
based on similar studies.22,27
Statistical Analysis
The data were analyzed using SPSS version 21 (SPSS, Inc., Chi-
cago, IL). Descriptive data are shown as mean, standard deviation of
mean, number of frequency, and their percentage. Kolmogorov-
Smirnov test was used to assess normal distribution of variables.
The c2 test and analysis of variance were used to examine the
homogeneity of groups for demographic and clinical information.
Owing to significant difference between groups in terms of
educational level, this variable was considered as a covariate.
Accordingly, the analysis of covariance, with Bonferroni correction,
was used to compare anxiety and physiological indicators between
the three studied groups. Moreover, the paired sample t test was
used for within-group comparison. The significance level was
considered less than 0.05 in all tests.
Results
Follow-up
All 90 patients completed the study and were included in the
final analysis (Figure 1).
Demographic and Clinical Variables
The number of illiterate patients was significantly higher in the
placebo group than in the foot group and hand group. No other
significant differences were observed between groups in terms of
demographic and clinical variables (Table 2).
Main Outcomes
The anxiety and physiological indicators of the three studied
groups are presented in Table 3. Anxiety (P < .001), HR (P ¼ .002),
and RR (P ¼ .009) decreased significantly after the intervention in
the hand group in comparison with those before intervention. The
same findings were found in the foot group for anxiety (P < .001),
HR (P < .001), and SBP (P < .001). However, anxiety increased
significantly in the placebo group after the intervention (P ¼ .014).
Compared with placebo massage, hand massage resulted in a
significant decrease in anxiety (P < .001) and HR (P < .001). Also in
the foot group, the same findings were obtained for anxiety
(P < .001) and HR (P ¼ .002). However, there was no significant
difference between hand group and foot group in any of the
measured outcomes.
Discussion
In this trial, we aimed to compare the effects of a 10-minute hand
or foot massage on preoperative anxiety in cataract surgery candi-
dates. Based on the findings, we could not find any significant dif-
ference between hand and foot massage in any of the measured
outcomes, showing the beneficial effects of both interventions on
preoperative anxiety. In line with our findings, Saatsaz et al19 indi-
cated no significant difference between foot massage, foot and hand
massage, and passive control groups after cesarean section in any of
the measured outcomes; however, the reduction of anxiety, RR, HR,
SBP, and DBP in the foot and hand massage group was greater than
that in the foot massage group. Latifi et al28 also indicated that foot
massage alone and also in combination with hand massage resulted
in a reduction of vital signs after cesarean section similarly in both
intervention groups. In this study, comparison was explored between
hand and foot massage groups, but Saatsaz et al19 and Latifi et al28
compared participants who received foot massage with those who
received hand massage in combination to foot massage, which
should be considered as the main difference.
We found that the anxiety level significantly decreased after hand
massage compared with placebo massage. Indeed, anxiety reduced
from a moderate level before measurements to a low level after
measurements in the hand massage group, while it remained at a
moderate level in the placebo group. In line with our findings, Kim
et al22 showed that anxiety was significantly lower in patients who

Please cite this article as: Farmahini Farahani M et al., Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized
Controlled Clinical Trial on Phacoemulsification Candidates, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2019.10.010
4 M. Farmahini Farahani et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx

Enrollment
Assessed for eligibility (n= 126)

Excluded (n=36)

Not meeting inclusion criteria (n= 27)

Declined to participate (n= 9)

Randomized (n= 90)

Allocation

Allocated to placebo massage (n= 30) Allocated to foot massage (n= 30) Allocated to hand massage (n= 30)

Received allocated intervention (n=30) Received allocated intervention (n= 30) Received allocated intervention (n=30)

Follow-Up

Lost to follow-up (n= 0) Lost to follow-up (n= 0) Lost to follow-up (n= 0)

Discontinued intervention (n= 0) Discontinued intervention (n= 0) Discontinued intervention (n= 0)

Analysis

Analyzed (n= 30) Analyzed (n= 30) Analyzed (n= 30)

Excluded from analysis (n= 0) Excluded from analysis (n= 0) Excluded from analysis (n= 0)

Figure 1. The CONSORT follow-up diagram of the patients' recruitment. This figure is available in color online at www.jopan.org.

had received hand massage therapy applied in the operating room
5 minutes before cataract surgery than in those who received no
intervention. Similarly, Cho reported significant difference in preop-
erative anxiety between hand massage and placebo massage
(handholding) after intervention in cataract surgery candidates.23
Moreover in ophthalmology surgery candidates, using local anes-
thesia, Nazari et al27 indicated a significantly lower preoperative
anxiety in patients who received 5-minute hand massage before
surgery (stroking and scrubbing methods by rubbing olive oil) than in
those who did not receive intervention.
Regarding physiological indicators of anxiety, we found that
only HR significantly decreased after hand massage in compari-
son with placebo massage. Inconsistent with the findings of
current trial, studies conducted by Kim et al,22 Cho,23 and Nazari
et al27 showed no significant difference between groups for any
physiological indicators. In another trial, Moon and Cho reported
that handholding during cataract surgery for about 15 minutes
resulted in a significant increase in DBP and a nonsignificant in-
crease in SBP and HR from the preoperative phase to intra-
operative phase.29 In contrast with the findings of Moon and Cho,
we found a nonsignificant increase for all indicators in the
handholding group from the point before measurements to after
measurements. The conflicting results might be due to differ-
ences in the intervention techniques, patients' characteristics,
type and techniques of surgery, and also time of outcome
assessment.

Table 2
Comparison of Demographic and Clinical Variables Between the Three Studied Groups

Variables Placebo Massage (n ¼ 30) Foot Massage (n ¼ 30) Hand Massage (n ¼ 30) P value

Age (year) 63.20 (10.52) 87.20 ± 12.85 63.66 ± 7.20 .340*

Marital status .357y
Single 0 (0.0) 1 (3.4) 0 (0.0)
Married 30 (100.0) 29 (96.6) 30 (100.0)
Educational level .046y
Illiterate 30 (100.0) 27 (90.0) 24 (80.0)
Under diploma 0 (0.0) 3 (10.0) 3 (10.0)
Diploma 0 (0.0) 0 (0.0) 3 (10.0)
History of other diseases .386y
Yes 10 (34.5) 9 (33.3) 15 (50.0)
No 20 (65.5) 21 (56.7) 15 (50.0)

All values are expressed as number (percentage) or mean ± standard deviation.

*
Obtained from analysis of variance.
y
Obtained from c2 test.

Please cite this article as: Farmahini Farahani M et al., Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized
Controlled Clinical Trial on Phacoemulsification Candidates, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2019.10.010
 M. Farmahini Farahani et al. / Journal of PeriAnesthesia Nursing xxx (xxxx) xxx 5

Table 3
Physiological Parameters and Anxiety of Patients Before and After the Intervention in Three Studied Groups

Variables Placebo Massage Foot Massage Hand Massage P

value*
Before After Change Before After Change Before After Change
Intervention Intervention Intervention Intervention Intervention Intervention

Anxietyy 3.73 ± 0.21 4.10 ± 0.23 0.36 ± 0.13z 4.03 ± 0.33 2.83 ± 0.24 1.20 ± 0.22z,x 3.73 ± 0.24 1.80 ± 0.20 1.93 ± 0.13z,x <.001
Heart rate 71.06 ± 1.88 72.66 ± 1.54 1.60 ± 0.98 71.60 ± 1.88 65.50 ± 1.18 6.10 ± 1.18z,x 73.66 ± 2.30 66.26 ± 2.98 7.40 ± 2.12z,x <.001
Respiratory rate 21.70 ± 0.64 21.93 ± 0.55 0.23 ± 0.44 20.36 ± 0.25 20.13 ± 0.16 0.23 ± 0.30 21.06 ± 0.54 20.06 ± 0.35 1.00 ± 0.35z .069
Systolic blood 117.00 ± 2.67 118.33 ± 2.91 1.33 ± 0.79 118.00 ± 2.31 114.00 ± 2.37 4.00 ± 0.90z 123.33 ± 3.00 142.33 ± 26.24 19.00 ± 26.64 .545
pressure
Diastolic blood 74.33 ± 1.56 75.00 ± 1.41 0.66 ± 0.95 76.66 ± 1.38 75.66 ± 1.32 1.00 ± 1.10 79.00 ± 1.61 75.66 ± 1.49 3.33 ± 1.87 .124
pressure

All values are presented as mean ± standard error.

*
Obtained from analysis of covariance, considering educational level as a covariate.
y
Measured by visual analogue scale that ranked the anxiety from 0 to 10.
z
Significant after the intervention in comparison to before the intervention: obtained from paired sample t test.
x
Significant in comparison to placebo massage: obtained from Bonferroni correction.

Similar to hand massage, anxiety level and HR significantly
decreased after foot massage in comparison with placebo massage.
Although there is growing body of evidence on the anxiolytic effect
of foot massage in a postoperative setting,11-14,17,18,20 limited data
are available on the effects of foot massage on preoperative anxiety.
In breast surgery candidates, it was found that preoperative anxiety
for patients who received foot massage was significantly lower than
that for those in the control group, which is in line with our find-
ings.10 Also, the present study supports previous studies that
indicated the positive effects of foot reflexology on preprocedural
anxiety.30e32
Although the exact mechanism of massage on anxiety is not
known, it seems that massage is a beneficial intervention that can
reduce or alleviate the perception of anxiety in surgery candidates.
It was proposed that massage could decrease perioperative anxiety
through stimulation and relaxation of tissues and muscles, by
increasing blood flow.19,22 Another hypothesis is that massage in-
creases the activity of the parasympathetic nervous system and
inhibits the sympathetic nervous system (reduces cortisol levels),
while increasing the release of certain chemical substances (ie,
serotonin and dopamine), thereby alleviating the level of anxiety.33
Limitations
The most important limitation of this study was that it was
conducted only on female candidates for cataract phacoemulsifi-
cation who had experienced a moderate level of anxiety before the
intervention, limiting the study's generalizability to other groups.
The reason that this study was merely conducted on female pa-
tients was cultural and religious limitations because massage was
planned to perform by a masseuse. Despite randomization, more
literate patients were included in the hand group or foot group;
hence, the educational level was considered as a covariate. More-
over, we could not blind the participants because of the nature of
massage therapy. However, none of the participants were aware of
the treatment type in the other groups because all massages were
performed in a private room. In addition, we could not control the
effects of the presence of patients' family members in the preop-
erative wards, which could be a confounding factor on patients'
anxiety.
Conclusions
Both foot or hand massage seems to be effective in reducing
preoperative anxiety in patients waiting for cataract surgery. These
types of massage could be applied for 5 to 10 minutes by perioper-
ative nurses as a noninvasive intervention for managing surgical
anxiety. It is recommended that certification programs and
continuing education programs in massage therapy be considered for
perioperative nurses as an alternative, holistic nursing practice. Also,
these programs should be presented to either patients or their family
members as a simple intervention before surgery to reduce preop-
erative anxiety.
Further research is recommended to consider gender role, long-
term consequences of the intervention, and also measuring other
physiological indicators of anxiety (ie, epinephrine, norepineph-
rine, cortisol, blood sugar). Moreover, it is of merit if only partici-
pants with high levels of anxiety are included in similar research to
better understand the clinical significance of change in anxiety
levels. It is also suggested to determine if the effect of the massage
on anxiety is still present when the patient enters the surgical room
or even during surgery. Moreover, the mechanisms behind the re-
ductions in preoperative anxiety in patients receiving foot or hand
massage requires further investigation.
Acknowledgments
The authors would like to appreciate the patients and nursing
staff of the ophthalmology unit of Arak Amirkabir Hospital, Iran, as
well as the assistant of the Vice Chancellor for Research and
Technology of Arak University of Medical Sciences. The authors
wish to thank Mr. H. Argasi at the Research Consultation Center
(RCC) of Shiraz University of Medical Sciences for his invaluable
assistance in editing this manuscript.
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Controlled Clinical Trial on Phacoemulsification Candidates, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2019.10.010
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