New guidelines suggest patients be screened for cannabis use prior to surgery
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Patients who undergo procedures requiring anesthesia should be asked about cannabis use, according to new guidelines released today by the American Society of Regional Anesthesia and Pain Medicine.
Per a release from the organization, the new guidelines were developed in response to the increased use of cannabis during the past 20 years and regarding concerns that it potentially can interact with anesthesia and lead to complications. Furthermore, the guidelines note that regular cannabis use may worsen pain and nausea following surgery and increase the need for opioids.
“About 10% of Americans use cannabis monthly,” the release stated, “and it is the most commonly used psychotropic substance after alcohol, according to the U.S. Substance Abuse and Mental Health Services Administration.”
“Before surgery, anesthesiologists should ask patients if they use cannabis — whether medicinally or recreationally — and be prepared to possibly change the anesthesia plan or delay the procedure in certain situations,” Samer Narouze, MD, PhD, senior author and ASRA Pain Medicine president stated in the release. “They also need to counsel patients about the possible risks and effects of cannabis. We hope the guidelines will serve as roadmap to help better care for patients who use cannabis and need surgery.”
Among the recommendations, anesthesiologists are urged to screen all patients for cannabis use, suggesting that queries on type of cannabis product used as well as manner, amount, frequency and recency of use.
Per the release, the guidelines were based on an extensive literature review and experiences from the organization’s Perioperative Use of Cannabis and Cannabinoids Guidelines Committee, composed of 13 experts that included anesthesiologists, chronic pain physicians and a patient advocate. They additionally cover preoperative, intraoperative and immediate postoperative care considerations.
The American Society of Anesthesiologists agreed with the guidelines’ recommendations and affirmed their value for anesthesiologists and surgeons.
“They are not intended to replace clinical judgement but rather promote improved patient communication and possibly improved outcomes,” ASRA stated in the release.
All recommendations are ranked using a grading system from A to D, including I. The highest grade support among the recommendations include: screening all patients before surgery; postponing elective surgery in patients who have altered mental status or impaired decision-making capacity at the time of surgery; counseling frequent, heavy users on the potentially negative effects of cannabis use on postoperative pain control; and counseling pregnant patients on the risks of cannabis use to an unborn child.
References:
- All patients should be screened for cannabis use before surgery, first U.S. guidelines recommend (press release). Available at: https://www.asra.com/news-publications/asra-updates/blog-landing/asra-updates/2023/01/03/all-patients-should-be-screened-for-cannabis-use-before-surgery-first-u.s.-guidelines-recommend. Published Jan. 3, 2023.