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What's your take/policy on doing ESI for pt. on herbal medication? Discontinuation for 7 days or doesn't matter?
ESI on herbal medication
- Thread starter ziggyziggy
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At ISIS a few years back Slipman recommended they be off all herbals with any anticoag effect for something weird like 4 days. I don't ask about herbals but I do know that when at the VA I did a stim trial on a guy who wouldn't quit bleeding after the leads were in and secured down. I literally had to hold pressure over the lead entry site for 45 min. Turned out he was a garlic lover. I worried for the next 48hrs that he was going to bleed and be paralyzed. All turned out ok in the end. Just some food for thought
same... i believe the only one that has data that was studied was Ginseng...and i dont remember it being good data.
ASRA has no opinion so i dont either...
Anesthetic Management of the Patient Receiving Herbal Therapy
Herbal drugs, by themselves, appear to represent no added significant risk for the development of spinal hematoma in patients having epidural or spinal anesthesia. This is an important observation since it is likely that a significant number of our surgical patients utilize alternative medications preoperatively and perhaps during their postoperative course.
1. The use of herbal medications alone does not create a level of risk that will interfere with the performance of neuraxial blocks. Mandatory discontinuation of these medications, or cancellation of surgery in patients in whom these medications have been continued, is not supported by available data.
2. Data on the combination of herbal therapy with other forms of anticoagulation are lacking. However, the concurrent use of other medications affecting clotting
mechanisms, such as oral anticoagulants or heparin, may increase the risk of bleeding
complications in these patients.
3. There is no wholly accepted test to assess adequacy of hemostasis in the patient
reporting preoperative herbal medications.
4. At this time, there do not seem to be specific concerns as to the timing of neuraxial
block in relationship to the dosing of herbal therapy, postoperative monitoring, or the timing of neuraxial catheter removal.
