Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes

Abstract

BackgroundDespite increases in cannabis use generally and for pain management, data regarding cannabis use in patients undergoing surgery are lacking. This study examined the prevalence of cannabis use among patients undergoing elective surgery and explored differences in clinical characteristics and surgical outcomes between cannabis users and non-cannabis users.MethodsThis prospective study included 1335 adults undergoing elective surgery. Participants completed self-report questionnaires preoperative and at 3-month and 6-month postsurgery to assess clinical characteristics and surgical outcomes.ResultsOverall, 5.9% (n=79) of patients reported cannabis use (53.2% medical, 19.0% recreational and 25.3% medical and recreational). On the day of surgery, cannabis users reported worse pain, more centralized pain symptoms, greater functional impairment, higher fatigue, greater sleep disturbances and more symptoms of anxiety and depression versus non-cannabis users (all p<0.01). Additionally, a larger proportion of cannabis users reported opioid (27.9%) and benzodiazepine use (19.0%) compared with non-cannabis users (17.5% and 9.2%, respectively). At 3 and 6 months, cannabis users continued to report worse clinical symptoms; however, both groups showed improvement across most domains (p≤0.05). At 6 months, the groups did not differ on surgical outcomes, including surgical site pain (p=0.93) or treatment efficacy (p=0.88).ConclusionsCannabis use is relatively low in this surgical population, yet cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

“…The results of this study showed higher levels of pain, poorer quality of life, and greater likelihood of using opioids or benzodiazepines in cannabis users compared with non-cannabis users prior to and 3 to 6 months following surgery. 123 Statement 1: Chronic use of THC may worsen postoperative pain, increase postoperative opioid use and precipitate the development of postoperative hyperalgesia. Level of certainty: Moderate Statement 2: There is a lack of high-quality evidence describing the risks of concomitant opioids and cannabinoids in the perioperative period and in addition few studies have addressed the benefits and risks of preoperative cannabinoid tapering.…”

“…[237][238][239] In the acute postoperative phase of care, MI, arrhythmias, stroke, cardiac arrest, and cardiomyopathy have been reported. 123 241 Mittleman et al interviewed 3882 patients with acute MI and conducted a case-crossover analysis that controlled for differences among patients, and found that within 1 hour after smoking marijuana, patients' risk of MI onset was elevated 4.8fold (95% CI 2.9 to 9.5; p<0.001) compared with periods of nonuse. 87 However, in the second hour after smoking, the relative risk was 1.7 (95% CI 0.6 to 5.1; p=0.34), suggesting a rapid decline in the cardiac effects of marijuana.…”

“…244 In addition, a retrospective pilot study investigating acute pain management in four trauma centers across the USA found that cannabis users reported higher pain scores and consumed larger quantities of opioids for management of acute pain (25%-37% higher) compared with non-cannabis users. 123 In addition, Jamal et al reported the effects of recreational cannabis smoking (prevalence 11.9%) on postoperative pain management within the first 24 hours after abdominal surgery. Cannabis users required a higher dose of postoperative morphine, extrapolated to 23% increased dose requirement in a model controlling for age, preoperative morphine use, and other comorbidities, and therefore increased vigilance to pain and opioid use in the postoperative phase may be required.…”

Minimizing opioid consumption by eliminating patient‐controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol

“…found that a preoperative history of cannabinoid use resulted in higher pain scores after major orthopedic surgery, as well as greater incidence of sleep interruption; postoperative opioid use was higher among patients who used cannabinoids preoperatively, however this was not statistically significant in this study. A similar article on elective surgery outcomes in patients who used cannabis reflected worse pain, greater functional impairment, and sleep disturbances associated with cannabis use, though overall surgical outcomes were comparable 23 . Thus, cannabinoid use may be a risk factor associated with poorer postoperative pain and consequently higher consumption of opioids after PIV.…”

“…A similar article on elective surgery outcomes in patients who used cannabis reflected worse pain, greater functional impairment, and sleep disturbances associated with cannabis use, though overall surgical outcomes were comparable. 23 Thus, cannabinoid use may be a risk factor associated with poorer postoperative pain and consequently higher consumption of opioids after PIV. As cannabinoid use has been reported to be more prevalent in the transgender community in comparison to the general population, this risk factor emphasizes the need to find ways to minimize opioid utilization during the postoperative recovery period for PIV patients.…”