- □ (A) Less centralized body pain
- □ (B) Similar satisfaction with surgical outcome
- □ (C) Worse surgical site pain
Cannabis use has been increasing in the United States, particularly in states where marijuana has been legalized both for medical and recreational use. Anesthesiologists and surgeons are faced with caring for these patients without strong data to guide discussion of perioperative outcomes and risks.
The authors of a recent longitudinal study examined perioperative outcomes in patients using cannabis. The study was conducted in Michigan following the medical legalization of marijuana in 2008 but prior to recreational legalization in 2018. Questionnaires were distributed to patients 18 years or older undergoing elective surgery. Patients were asked to complete a questionnaire on the day of surgery, as well as at two weeks, one month, three months, and six months after surgery. Each participant was paid $10 for each completed questionnaire, for a potential total of $50 per patient.
“The use of cannabis continues to rise in the U.S. patient population, and there is limited guidance for clinicians on perioperative considerations for cannabis users.”
Among a study cohort of 1,335 patients undergoing elective surgery, 79 cannabis users were identified (5.9%). The clinical characteristics associated with cannabis use included younger age, male sex, receipt of disability benefits, and a lower level of education. At baseline, these patients had worse overall pain severity, greater functional impairment, greater sleep disturbance, more anxiety and depression, and more centralized pain symptoms. Cannabis users were also more likely to report baseline use of benzodiazepines and opioids compared with non-cannabis users.
In addition to baseline pain and function, the study examined centralized pain, surgical site pain, and patient satisfaction. Cannabis users reported more severe surgical site pain on the day of surgery and at the three-month follow-up compared with non-cannabis users. However, at six months, there was no difference in surgical site pain or patient satisfaction between groups. Cannabis users continued to report worse centralized pain symptoms, more functional impairment, and higher overall pain (pain not related to surgery) severity in comparison to non-cannabis users.
The use of cannabis continues to rise in the U.S. patient population, and there is limited guidance for clinicians on perioperative considerations for cannabis users. This surgical cohort shows that patients who use cannabis score higher on functional impairment, report worse pain severity, and are more likely to use opioids or benzodiazepines compared with non-cannabis users. Despite these differences, cannabis users were found to have similar improvement after surgery at six months, suggesting cannabis use did not adversely affect surgical recovery.