Recommendations developed relating to cannabis use before surgery

In consensus guidelines issued by the American Society of Regional Anesthesia and Pain Medicine and published online Jan. 5 in Regional Anesthesia & Pain Medicine, recommendations are presented for the perioperative management of patients who consume cannabis.

Shalini Shah, M.D., from UC Irvine Health in Orange, California, and colleagues examined the health implications of cannabis use. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee drafted responses to nine key questions with a goal of developing recommendations focusing on the safe management of surgical patients using cannabinoids. A modified Delphi method was used, and 100 percent consensus was achieved on third-round voting.

The authors developed four recommendations that received grade A support, indicating strong evidence: (1) universal screening for cannabinoids before surgery, which should include the type of product, time of last consumption, route of administration, amount, and frequency of use; (2) postponing elective surgery for those with altered mental status or impaired decision-making at the time of surgery; (3) counseling frequent users regarding the potential negative effects of cannabis use on postoperative pain control; and (4) providing education and counseling to pregnant patients regarding risks to the unborn child.

"Cannabinoid use in the perioperative setting has significant potential negative medical implications," the authors write. "We hope these guidelines will help both clinicians and researchers in their pursuit of optimal patient care."

One author disclosed financial ties to the pharmaceutical industry.