MEDICINES AND SUPPLEMENTS IN SPINE SURGERY
Alternative Medicine (i.e. medicine other than prescription drugs and
regulated “over the counter” medicines) forms a prominent
part of the treatment spectrum available to patients.
Visits to alternative therapy practitioners probably exceed those made
to conventional medical practitioners at this time in South Africa.
The commonest use of alternative medication is probably the use of Herbal
remedies and Supplements or Homeopathic medicines.
These are freely available to patient from Practitioners or as “on
the shelf” products.
Manufacturers of non-conventional medicines are not bound by law to disclose
any information about their products with respect to possible side effects
or inter-action with other drugs.
Inclusion of information leaflets about some medicines are sometimes provided,
and should always be read.
Patients freely use Herbal remedies in the belief that they are harmless
food supplements. In fact most Herbal remedies are highly effective drugs.
Like conventional medicines, they can also produce unwanted side effects
of various degrees or interact in a predicted or un-predicted way with
other medicines, both alternative and conventional. We therefore have
to realize that “natural” does not always means “safe”.
In the belief that “more is better” patients may exceed recommended
dosages of Herbal medicines thus increasing the potential for unwanted
Patients often use these remedies for low-grade symptoms for which they
do not regard it necessary to consult their conventional doctors. These
complaints include back problems, headaches, tiredness, anxiety, mild
depression, sleeplessness and various conditions of the gastro-intestinal
and urinary tracts
A six year study in die USA of more than 2500 elective non-cardiac surgery
patients revealed that:
a. 39% of these patients reviewed used alternative medical supplements.
b. 44% did not tell their primary physician about their use of these drugs.
c. 56% did not inform their anaesthesiologist before surgery
Like conventional medicines herbal medicines may produce effects that
might cause unexpected adverse effects and side effects in patients undergoing
A significant number of these have an influence on the blood clotting
mechanism and may in fact enhance bleeding during surgery or directly
afterwards with possible disastrous results. Some of these medicines may
also interact with standard medication and anaesthetic agents.
It is therefore of the utmost importance that patients:
a. Fully inform their primary physicians and especially the anaesthesiologist
about their use of alternative (Herbal/natural/homeopathic) medicines.
b. In cases of elective surgery use of these supplements should, for safety
reasons, be discontinued at least 7 days prior to surgery if they are
not given for a life supporting reason.
The following table lists different products which may influence bleeding.
Some of these effects are documented and referenced while others are un-referenced
potential effects on the blood-clotting mechanism.
Aconite, Alfalfa, Aniseed, Arnica, Asafetida, Starflower (Borage), Capsaicin,
Celery, Chamomile, Cong Quai, Fenugreek, Feverfew, Garlic, Ginger, Gingo
(Ginkgo Biloba), Ginseng, Horse Chestnut, Horseradish, Kava Kava, Licorice,
Meadowsweet, Motherwort, Passionflower, Poplar, Red Clover, St. John’s
REMEMBER: PLEASE FULLY INFORM YOUR SURGEON AND
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