ASRA Guidelines: Herbal Supplementation

Basic, Basic Sciences

ASRA’s recommendation for herbal supplementation is graded as a 1C (strong recommendations; some key evidence supporting the recommendation is of low quality). Despite the widespread use of herbal medications, there are few controlled clinical trials supporting the efficacy or investigating adverse effects of the supplementations on surgical patients. However, there are several isolated case reports, which illustrate their potentially dramatic clinical effects. For example, Rose et al described an instance of spontaneous spinal epidural hematoma leading to paraplegia caused by a qualitative platelet disorder in the setting of excessive garlic ingestion.2 Additionally, there are several published cases of clinically significant hemorrhage related to Gingko Biloba ingestion. Vale S et al published a report of a 61-year-old man who presented with a subarachnoid hemorrhage assumed to be caused by his Gingko Biloba ingestion over the previous six months.3


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Eryn Thiele, MD