Expert panel created consensus guidelines for managing cannabis users before and after surgery
A panel of 17 experts used a Delphi process to develop recommendations for perioperative cannabis management, including screening, potential weaning, extra nausea prevention, and anticipating higher pain medication needs.
Quick Facts
What This Study Found
Major consensus recommendations included: elicit and quantify cannabis use history, contact the cannabis authorizer if one exists, consider perioperative cannabis weaning, provide additional postoperative nausea/vomiting prophylaxis, pay extra attention to anesthetic depth monitoring, anticipate increased postoperative analgesic requirements, and watch for cannabis withdrawal syndrome.
Key Numbers
17 expert panelists. 4 independent reviewers. Key recommendations: screen for cannabis use, consider weaning, extra PONV prophylaxis, monitor anesthetic depth, anticipate higher analgesic needs, watch for withdrawal.
How They Did This
Modified Delphi method with 17 expert panelists. Literature review followed by blinded rater forms, analysis for consensus, unblinded discussion, draft recommendations, and review by 4 independent reviewers (surgeon, nurse practitioner, 2 patients).
Why This Research Matters
As cannabis use increases, more surgical patients use cannabis regularly. Without guidelines, clinicians may not know that cannabis users may need different anesthetic management, more pain medication, and monitoring for withdrawal. These are the first formal consensus recommendations.
The Bigger Picture
Cannabis interacts with anesthetic agents, pain pathways, and recovery in ways most surgeons and anesthesiologists were not trained to manage. As use normalizes, perioperative cannabis protocols could become as routine as preoperative tobacco cessation counseling.
What This Study Doesn't Tell Us
Consensus-based, not evidence-based. Limited randomized trial data available. Expert opinion subject to bias. Recommendations may not apply to all cannabis products or use patterns.
Questions This Raises
- ?How far in advance of surgery should cannabis weaning begin?
- ?What is the magnitude of increased analgesic need?
- ?Can perioperative cannabis guidelines reduce complications?
Trust & Context
- Key Stat:
- First formal consensus guidelines for perioperative cannabis management
- Evidence Grade:
- Rigorous Delphi methodology but based on limited underlying evidence. Strong consensus process compensates somewhat for weak evidence base.
- Study Age:
- 2021 consensus recommendations via modified Delphi process.
- Original Title:
- Perioperative Pain and Addiction Interdisciplinary Network (PAIN): consensus recommendations for perioperative management of cannabis and cannabinoid-based medicine users by a modified Delphi process.
- Published In:
- British journal of anaesthesia, 126(1), 304-318 (2021)
- Authors:
- Ladha, Karim S(4), McLaren-Blades, Alexander(2), Goel, Akash(2), Buys, Michael J, Farquhar-Smith, Paul, Haroutounian, Simon, Kotteeswaran, Yuvaraj, Kwofie, Kwesi, Le Foll, Bernard, Lightfoot, Nicholas J, Loiselle, Joel, Mace, Hamish, Nicholls, Judith, Regev, Aviva, Rosseland, Leiv Arne, Shanthanna, Harsha, Sinha, Avinash, Sutherland, Ainsley, Tanguay, Rob, Yafai, Sherry, Glenny, Martha, Choi, Paul, Ladak, Salima S J, Leroux, Timothy Sean, Kawpeng, Ian, Samman, Bana, Singh, Rajbir, Clarke, Hance
- Database ID:
- RTHC-03269
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
Should I stop using cannabis before surgery?
The expert panel recommends considering cannabis weaning before surgery. Cannabis users may need more anesthesia, more pain medication afterward, and may experience withdrawal symptoms if they stop abruptly.
Does cannabis affect anesthesia?
Yes. The guidelines recommend extra attention to monitoring anesthetic depth in cannabis users, additional nausea/vomiting prevention, and anticipating higher postoperative pain medication needs.
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Cite This Study
https://rethinkthc.com/research/RTHC-03269APA
Ladha, Karim S; McLaren-Blades, Alexander; Goel, Akash; Buys, Michael J; Farquhar-Smith, Paul; Haroutounian, Simon; Kotteeswaran, Yuvaraj; Kwofie, Kwesi; Le Foll, Bernard; Lightfoot, Nicholas J; Loiselle, Joel; Mace, Hamish; Nicholls, Judith; Regev, Aviva; Rosseland, Leiv Arne; Shanthanna, Harsha; Sinha, Avinash; Sutherland, Ainsley; Tanguay, Rob; Yafai, Sherry; Glenny, Martha; Choi, Paul; Ladak, Salima S J; Leroux, Timothy Sean; Kawpeng, Ian; Samman, Bana; Singh, Rajbir; Clarke, Hance. (2021). Perioperative Pain and Addiction Interdisciplinary Network (PAIN): consensus recommendations for perioperative management of cannabis and cannabinoid-based medicine users by a modified Delphi process.. British journal of anaesthesia, 126(1), 304-318. https://doi.org/10.1016/j.bja.2020.09.026
MLA
Ladha, Karim S, et al. "Perioperative Pain and Addiction Interdisciplinary Network (PAIN): consensus recommendations for perioperative management of cannabis and cannabinoid-based medicine users by a modified Delphi process.." British journal of anaesthesia, 2021. https://doi.org/10.1016/j.bja.2020.09.026
RethinkTHC
RethinkTHC Research Database. "Perioperative Pain and Addiction Interdisciplinary Network (..." RTHC-03269. Retrieved from https://rethinkthc.com/research/ladha-2021-perioperative-pain-and-addiction
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.