Anesthesiologists issue painful pot warning in new guidelines.

MedPage Today shares a painful finding from the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine), who have issued guidelines for pre-operative treatment based on findings that people who use cannabis are likely to feel more pain after surgery:

Cannabis is the most commonly used recreational drug in the U.S. and the most commonly used psychoactive substance after alcohol, noted guideline co-author and ASRA Pain Medicine president Samer Narouze, MD, PhD, of Northeast Ohio Medical University in Akron.

About 10% of the population — 27.6 million people — reported monthly use in 2017, according to data from the Substance Abuse and Mental Health Services Administration (SAMHSA) and that number is growing, Narouze added. Recent Gallup poll numbers place the number of Americans who smoke marijuanaopens in a new tab or window at about 16%.

“That’s why we’ve been working on these guidelines for the last 2 years, because we have millions of people using cannabis recreationally or medicinally,” Narouze said in an interview with MedPage Today.

But even in observational studies, patterns were clear, Narouze noted.”The main issue we’re seeing is more pain in recovery and more nausea and vomiting, also in recovery,” he observed.

“We also saw associations with increased risk for post-operative cardiovascular morbidity — post-operative myocardial infarction and arrhythmias — and post-operative cerebrovascular morbidity in some patients,” he said.

Cannabis had varying interactions with anesthetics and sedatives, Narouze added. Some patients also experienced post-operative cannabis withdrawal symptoms.

C grade recommendations included delaying elective surgery for at least 2 hours after patients smoked cannabis, adjusting anesthesia delivery based on symptoms and timing of last cannabis consumption, increasing vigilance of potential heart and neurological problems after surgery, using multimodal pain control including opioids if needed, and using a cannabinoid agonist like dronabinol to treat severe cannabis withdrawal symptoms post-operatively.

“There’s a large gap in our knowledge about cannabis and surgery,” Narouze stated. “That’s why most recommendations did not reach the grade A level.”