The American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) has released new guidelines surrounding cannabis use in relation to surgery, advocating for all patients undergoing procedures with anesthesia to be screened for cannabis use.
The guidelines come as cannabis use has risen in the United States over the last few decades, with several states relaxing criminal penalties and legalizing medicinal and recreational use. ASRA is concerned that cannabis could interact with anesthesia, and the guidelines also note that regular cannabis use may worsen pain and nausea after surgery and increase the need for opioids. Currently, about 10% of U.S. adults use cannabis monthly, according to the U.S. Substance Abuse and Mental Health Services Administration.
ASRA’s guidelines advise asking patients about their cannabis use prior to surgery. The guidelines are the first such on perioperative (before, during and after surgery) management of cannabis, according to lead researcher Shalini Shah, MD, vice chair of anesthesiology at the University of California at Irvine School of Medicine.
“Before surgery, anesthesiologists should ask patients if they use cannabis––whether medicinally or recreationally––and be prepared to possibly change the anesthesia plan or delay the procedure in certain situations,” Samer Narouze, MD, PhD, senior author and ASRA Pain Medicine president, said in a statement. “They also need to counsel patients about the possible risks and effects of cannabis. For example, even though some people use cannabis therapeutically to help relieve pain, studies have shown regular users may have more pain and nausea after surgery, not less, and may need more medications, including opioids, to manage the discomfort.”
The guidelines also advocate for asking patients how they use cannabis, including the type of cannabis product, if it was smoked, ingested or other, the amount used and frequency of use.
The industry group relied on its “Perioperative Use of Cannabis and Cannabinoids Guidelines Committee,” which is composed of 13 experts, including anesthesiologists, chronic pain physicians and a patient advocate, as well as an extensive literature review to come up with its guidelines.
The guidelines cover preoperative, intraoperative and immediate postoperative care considerations, and are not intended to replace clinical judgement, but rather promote improved patient communication and possibly improved outcomes. The American Society of Anesthesiologists (ASA) is also in agreement with the recommendations in the guidelines.
In addition to screening patients about their cannabis use, the guidelines recommend educating patients about the potential risks of continued cannabinoids before, during and after surgery, as well as discourage use during pregnancy and following childbirth. The guidelines also get specific about cannabis use, such as delaying surgery for at least two hours after smoking cannabis due to increased risk of heart attack before, during or after surgery. Plus, surgeons are advised to increase vigilance of heart and neurological problems, and more.
See the guidelines here.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."