The American Society of Regional Anesthesia (ASRA) and Pain Medicine calls for cannabis testing before surgery.
The new guidelines are the result of two years of work at ASRA Pain Medicine. The guidelines noted that the idea initially came from cannabis and perioperative medicine special interest groups within the society in November 2020. The group is one of the world’s largest medical societies dedicated to anesthesiology, with 5,000 members in 66 countries.
A smaller task force broke it down into numerous questions to answer, the first of which was whether all surgical and procedural patients requiring anesthesia were screened for preoperative cannabinoids and, if so, what information should be to get
The most fundamental part of their answer is a big yes because everything in a patient’s medical and recreational substance use history should be considered, the guideline authors noted.
“Prior to surgery, anesthesiologists should ask patients if they use cannabis, either medicinally or recreationally, and be prepared to change the anesthesia plan or delay the procedure in certain situations,” said Samer Narouze, MD, Ph.D., lead author and senior author. ASRA Pain Medicine Chair.
Narouze went on to point out that while some people use cannabis therapeutically, studies have shown that regular users may have more pain and nausea after surgery, not less, and may need more medication, including opioids. to manage discomfort. And they are not scary, they just want the patient and the anesthesiologist to be as informed as possible.
“We hope the guidelines will serve as a road map to help better care for patients who use cannabis and need surgery,” said Narouze.
The authors note that it was not just the weed that worried them, but the potential for pesticides, heavy metals and carcinogens. There are concerns about adulterants affecting the perioperative efficacy of anesthesia.
The authors later broke it down into four main factors for considering whether someone should stop using cannabis before surgery: it was medical, dosage and frequency of use, CBD ratios, and how it’s administered.
“A recent consensus-based guideline recommended reducing cannabinoid use 7 days before surgery (to less than 1.5 g/day smoked cannabis, 300 mg/day CBD oil, 20 mg/day of THC oil) while cautioning not to attempt any tapering strategies within 6 days of elective surgery and not to attempt tapering 1 day prior to surgery,” the guidelines noted.
The guidelines also noted that one of the places where ASRA Pain Medicine will study the relationship between cannabis and anesthesia will be more common in pregnant women. In 2019, 5.4% of pregnant women reported having used marijuana during pregnancy. The guidelines said that a history of occasional or recreational marijuana use probably does not pose a risk with neuraxial anesthesia for labor or cesarean section analgesia.
The authors noted that if you go into labor within a couple of hours of consuming cannabis, there may be an increased potential for cardiovascular, anesthetic and vasopressor interactions.
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