ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids.
acute pain
ambulatory care
analgesics, opioid
obstetrics
Journal
Regional anesthesia and pain medicine
ISSN: 1532-8651
Titre abrégé: Reg Anesth Pain Med
Pays: England
ID NLM: 9804508
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
27
08
2022
accepted:
08
11
2022
pubmed:
4
1
2023
medline:
27
1
2023
entrez:
3
1
2023
Statut:
ppublish
Résumé
The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
Sections du résumé
BACKGROUND
The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.
METHODS
In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.
RESULTS
Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.
CONCLUSIONS
Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
Identifiants
pubmed: 36596580
pii: rapm-2022-104013
doi: 10.1136/rapm-2022-104013
doi:
Substances chimiques
Cannabinoids
0
Analgesics
0
Cannabinoid Receptor Agonists
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
97-117Informations de copyright
© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: SS discloses consultant honorarium from Masimo, Allergan and SPR Therapeutics. HC is supported in part by a Merit Award from the Department of Anesthesiology and Pain Medicine at the University of Toronto (Toronto, Canada). The remaining authors declare no competing interests.