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ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids
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  1. Shalini Shah1,
  2. Eric S Schwenk2,
  3. Rakesh V Sondekoppam3,
  4. Hance Clarke4,
  5. Mark Zakowski5,
  6. Rachel S Rzasa-Lynn6,
  7. Brent Yeung7,
  8. Kate Nicholson8,
  9. Gary Schwartz9,10,
  10. W Michael Hooten11,
  11. Mark Wallace12,
  12. Eugene R Viscusi2 and
  13. Samer Narouze13
  1. 1 Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
  2. 2 Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  3. 3 Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA
  4. 4 Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
  5. 5 Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  6. 6 Anesthesiology, University of Colorado Health, Aurora, Colorado, USA
  7. 7 Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
  8. 8 National Pain Advocacy Center, Golden, Colorado, USA
  9. 9 AABP Integrative Pain Care, Melville, New York, USA
  10. 10 Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
  11. 11 Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
  12. 12 Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
  13. 13 Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
  1. Correspondence to Dr Shalini Shah, Department of Anesthesiology, UC Irvine Healthcare, Orange, CA 92868, USA; ssshah1{at}hs.uci.edu

Abstract

Background The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.

Methods In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.

Results Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.

Conclusions Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.

  • analgesics, opioid
  • acute pain
  • obstetrics
  • ambulatory care

Data availability statement

Data such as group vote tallies and comments on each Delphi round are available upon request.

https://doi.org/10.1136/rapm-2022-104013

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    Data availability statement

    Data such as group vote tallies and comments on each Delphi round are available upon request.

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    Supplementary materials

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    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Twitter @ShaliniShahMD, @ESchwenkMD, @rakesh6282, @drhaclarke, @garyschwartzmd, @NarouzeMD

    • Correction notice This article has been corrected since it published Online First. The title and heading for question 6 has been updated as well as reference 3 and the first line of the background paragraph.

    • Contributors All authors contributed to the researching, drafting, and final writing and approval of this manuscript. SS is the guarantor for this manuscript and accepts full responsbility for its content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SS discloses consultant honorarium from Masimo, Allergan and SPR Therapeutics. HC is supported in part by a Merit Award from the Department of Anesthesiology and Pain Medicine at the University of Toronto (Toronto, Canada). The remaining authors declare no competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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