HERBAL 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 clinical results.

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 surgery.
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 Wort, Willow

REMEMBER: PLEASE FULLY INFORM YOUR SURGEON AND ANAESTHESIOLOGIST

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