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.
Anesthesiologists, surgeons, perioperative nurses, and cannabis-using patients facing surgery.
First formal consensus guidelines for perioperative cannabis management
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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).
What this study cannot 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.
How to read the evidence
Rigorous Delphi methodology but based on limited underlying evidence. Strong consensus process compensates somewhat for weak evidence base.
When this study was published
2021 consensus recommendations via modified Delphi process.
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.
Questions still open
- How far in advance of surgery should cannabis weaning begin? What is the magnitude of increased analgesic need? Can perioperative cannabis guidelines reduce complications?
Common questions
Should I stop using cannabis before surgery?
Does cannabis affect anesthesia?
Read the original research
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
Citation
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
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