The American Society of Regional Anesthesia (ASRA) and Pain Medicine is calling for cannabis screenings prior to surgery. 

The new guidelines come as a result of two years of work at ASRA Pain Medicine. The guidelines noted the idea initially came from cannabis and perioperative medicine special interest groups within the society in November 2020. The group is one of the largest medical societies dedicated to anesthesiology in the world, with 5,000 members in 66 countries. 

A smaller working group broke it down into numerous questions to answer, the first of which was if all surgical and procedural patients requiring anesthesia be screened for cannabinoids preoperatively, and if so, what information should be obtained?

The most fundamental part of their answer is a big yes because everything in a patient’s medical and recreational substance history should be taken into account, the guideline authors noted.

“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,” said Samer Narouze, M.D., Ph.D., senior author and ASRA Pain Medicine president. 

Narouze went on to point out that while some people use cannabis therapeutically, studies have shown regular users may have more pain and nausea after surgery, not less, and may need more medications, including opioids, to manage the discomfort. And they’re not fearmongering, they just want the patient and 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,” Narouze said. 

The authors note it wasn’t just the weed they were worried about, but the potential for pesticides, heavy metals, and carcinogens. There are concerns about those adulterants impacting the perioperative effectiveness of the anesthesia. 

The authors later broke it down to four main factors to consider on whether someone should stop using cannabis before surgery — it was medical, the dosing and frequency of use, CBD ratios, and how it’s administered. 

“A recent consensus-based guideline recommended reducing cannabinoid use 7 days prior to surgery (to less than 1.5 g/day of smoked cannabis, 300 mg/day of 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 a day prior to surgery,” the guidelines noted. 

The guidelines also noted one of the places the ASRA Pain Medicine will be looking at the relationship between cannabis and anesthesia the most often will be in pregnant women. In 2019, 5.4% of pregnant women reported using marijuana during their pregnancy. The guidelines said a history of occasional or recreational use of marijuana likely does not pose a risk with neuraxial anesthesia for labor analgesia or cesarean delivery.

The authors did note if you were to go into labor within a couple of hours of consuming cannabis there may be increased potential for cardiovascular, anesthetic, and vasopressor interactions.

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