Pre-op Cannibis Use Associated More Post-Op Pain, Opiate Use

In an online-first article in Anesthesia News a study presented at the 2022 annual meeting of the American Society of Anesthesiologists found adults who use cannabis have more pain after surgery and consume more opiates than those who don’t use the drug,

Elyad Ekrami, MD, a lead author of the study and clinical research fellow of the Outcomes Research Department at Cleveland Clinic’s Anesthesiology Institute said “Cannabis is the most commonly used illicit drug in the United States and increasingly used as an alternative treatment for chronic pain, but there is limited data that shows how it affects patient outcomes after surgery. Our study shows that adults who use cannabis are having more, not less, postoperative pain. Consequently, they have higher opioid consumption after surgery.”

Researchers analyzed the records of 34,521 adult patients, 1,681 of them cannabis users, who had elective surgeries at Cleveland Clinic from January 2010 to December 2020. The cannabis users had used the drug within 30 days before surgery, while the other patients had never used cannabis. The patients who used cannabis experienced 14% more pain during the first 24 hours after surgery compared with those who never used cannabis. In addition, patients who used cannabis consumed 7% more opioids after surgery, which the authors note was not statistically significant, but is likely clinically relevant.

“The association between cannabis use, pain scores and opioid consumption has been reported before in smaller studies, but they’ve had conflicting results,” Ekrami said. “Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our results. Furthermore, our study groups were balanced by confounding factors including age, sex, tobacco and other illicit drug use, as well as depression and psychological disorders.” 

Additional research is needed to further define cannabis’ effects on surgical outcomes. Ekrami concluded “Physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multi-modal approach to post-surgical pain control.”

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