All surgical patients in the US are now required to educate themselves about their cannabis use

Like it or not, all patients in the US may now need to be screened for cannabis use prior to surgery

New guidelines just released by the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) recommend that all people undergoing surgery that require anesthesia be screened for their marijuana use.

ASRA Pain Medicine is one of the largest medical organizations specializing in anesthesiology, founded back in 1975. It currently has over 5,000 members on 6 continents.

These are the first-ever guidelines to be published in the United States containing such recommendations. Doctors and medical professionals state that regular cannabis use can actually lead to an increased risk of post-operative nausea and pain, resulting in patients requiring opioids.

ASRA Pain Medicine explains that the guidelines were released due to the increase in use of cannabis over the past 20 years, despite legitimate concerns that cannabis may have undesirable interactions with anesthesia. “Prior to surgery, anesthesiologists should ask patients if they use cannabis, whether medicinally or recreationally, and be prepared to potentially change the anesthesia schedule or delay the procedure in certain situations,” said Samer Narouze, MD, Ph. D., ASRA Pain Medicine’s President and the senior author of the guidelines.

This is not news as there have been numerous studies in the past pointing out the potential dangers and risks of cannabis use if not avoided prior to surgery. More on that below.

So is it fair that patients are screened for cannabis use before surgery? This can be a valid point and one of those situations where it can be in the patient’s interest to actually refrain from doing so as it can do more harm than good.

“They also need to advise patients on the potential risks and effects of cannabis. For example, although some people use cannabis therapeutically to relieve pain, studies have shown that regular users may experience more pain and nausea after surgery, not less, and may need more medication, including opioids, to manage the discomfort it in the guidelines. “We hope the guidelines will serve as a roadmap to better care for patients who use cannabis and require surgery,” it said.

What Studies Say

Recent studies point to the risks and dangers that marijuana users face during surgery. That’s why it’s best to abstain before going under the knife.

In a 2022 study, the results of which were presented during the 2022 Anesthesiology Annual Meeting, cannabis users tended to experience more pain after surgery. Researchers analyzed medical records of 34,521 adult patients, 1,681 of whom were marijuana users, who all underwent surgery at the Cleveland Clinic from January 2010 to December 2020. They found that marijuana users who had used the drug within a month prior to surgery were found to experience 14% more pain within 24 hours of surgery than non-marijuana users.

In addition, patients using cannabis required 7% more opioids after surgery.

“The association between cannabis use, pain scores, and opioid use has been reported in smaller studies, but they have had conflicting results,” notes Dr. Elyad Ekrami, MD, the study’s lead author and a Clinical Research Fellow at the Cleveland Clinic Anaesthesiology Institute. “Our study has a much larger sample size and does not include patients with a chronic pain diagnosis or patients who received regional anesthesia, which would have seriously conflicted with our results. In addition, our study groups were balanced by confounding factors such as age, gender, tobacco and other illicit drug use, and depression and mental disorders,” he said.

dr Ekrami adds that doctors need to take note of patients who use cannabis as it impacts their outcomes, particularly because they may need more painkillers or opioids post-surgery. “Physicians should keep in mind that patients using cannabis may experience more pain and require slightly higher doses of opioids post-surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” says Dr. Ekrami.

Meanwhile, another 2019 study showed another impact of cannabis on surgeries: more anesthesia required. dr Mark Twardowski of Colorado’s Western Medical Associates, the study’s lead author, explains that using cannabis before surgery will have an impact on patient medical care. dr Twardowski and his team analyzed 250 patients undergoing minimally invasive procedures that required anesthesia in the state where cannabis has long been legal for recreational use.

Ten percent of the patients reported being regular cannabis users. These people needed more than double the amount of propofol, an anesthetic. In addition, cannabis users also required 14% more fentanyl for pain and midazolam for calming.

“Cannabis users cannot assume that their use will not impact their medical care,” explains Dr. Twardowski. “Of course, the fact that use affects the effectiveness of these three drugs raises countless questions about possible effects on other drugs (pain relievers, anxiety relievers, etc.),” ​​he told Reuters via email.

He also explains that due to the length of time cannabis stays in the human body, it could actually take months before its effects stop interfering with surgical outcomes. “Patients absolutely must inform their doctors about cannabis use before any procedure,” he advises.

Conclusion

If you are about to have any type of procedure that requires anesthesia, it’s important to be open with your doctor about your marijuana use. Failure to do this can result in an extremely uncomfortable experience as you may feel the pain even without proper anesthesia.

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