A randomized-controlled trial of nabilone for the prevention of acute postoperative nausea and vomiting in elective surgery

Levin, David; Dulberg, Zachary; Chan, An‐Wen; Hare, Gregory M. T.; Mazer, C. David; Hong, Aaron

doi:10.1007/s12630-017-0814-3

Cited by 48 publications

(57 citation statements)

References 31 publications

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“…13,34,35 One RCT achieved a low risk of bias rating on all domains. 24 Most observational studies were rated as being at high risk of bias for confounding, selection and measurement bias. We also identified selective outcome reporting bias in 5 studies.…”

Section: Methodologic Qualitymentioning

confidence: 99%

“…Of the 33 included studies, 5 were RCTs, 13,24,34,35,50 1 was a nonrandomized intervention study, 29 8 were case reports/ case series, 30,31,[36][37][38][39]51,52 6 were surveys, [25][26][27][28]53,54 1 was a qualitative study 54 and 12 were systematic reviews. 32,33,40,[41][42][43][44][45][46][47][48][49] Of the 12 systematic reviews, 9 included RCTs, 32,[41][42][43][44][45][46][47]49 2 included nonrandomized studies 33,40 and 1 review 48 was unclear on the design of the included studies.…”

Section: Methodsmentioning

confidence: 99%

“…The mean percentage of correctly reported items was 69% for RCTs, 65% for observational studies and 65% for systematic reviews (means exclude studies that were abstracts only). Some individual studies performed well on the reporting tools; 5 studies scored 80% or higher, [24][25][26][27][28] including 1 study that scored 100%. 26 However, 6 studies scored 50% or lower (excluding abstracts).…”

Section: Reporting Qualitymentioning

confidence: 99%

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Cannabis for pain in orthopedics: a systematic review focusing on study methodology

Madden

George

Hoek

et al. 2019

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Background: Medical cannabis use is an emerging topic of interest in orthopedics. Although there is a large amount of literature on medical cannabis use for managing various types of pain, few studies have focused on orthopedic conditions. There is little high-quality evidence in core orthopedic areas. The objective of this study was to summarize the literature on the efficacy of cannabis use for pain related to orthopedic conditions. Methods: We conducted a systematic review of the literature on the use of cannabinoids for pain management in core orthopedic conditions. Two independent reviewers extracted information on reporting quality, risk of bias, drugs, population, control, duration of study, pain outcomes and the authors' conclusions regarding efficacy for pain outcomes. Results: We identified 33 orthopedic studies, including 21 primary studies and 12 reviews. Study quality was generally low to moderate. Six of the included studies had a control group and 15 were noncontrolled studies. Methodologies, drugs and protocols of administration varied greatly across studies. Study conclusions were generally positive in noncontrolled studies and mixed in controlled studies. Studies using higher doses tended to conclude that cannabis use was effective, but the potential for harmful effects may also be increased with higher doses. Conclusion: Variability in the methodologies used in cannabis research makes it challenging to draw conclusions about dosing, routes and frequency of administration. Most of the existing evidence suggests that medical cannabis use is effective, but this efficacy has been demonstrated only when either there is no comparator or cannabis is compared with placebo. Studies using an active comparator have not demonstrated efficacy. Future research should focus on improving study reporting and methodologic quality so that protocols that optimize pain control while minimizing harmful effects can be determined. Contexte : La consommation de cannabis à des fins médicales est un sujet d'intérêt émergent en orthopédie. Malgré l'existence d'un important corpus de littérature médicale sur l'utilisation du cannabis pour traiter divers types de douleurs, peu d'études ont porté sur les problèmes orthopédiques. On dispose de peu de données probantes de grande qualité relatives aux principaux domaines de l'orthopédie. L'objectif de cette étude était de résumer la littérature sur l'efficacité du cannabis à soulager les douleurs orthopédiques. Méthodes : Nous avons réalisé une revue systématique de la littérature sur l'utilisation des cannabinoïdes pour la prise en charge de la douleur associée aux principaux problèmes orthopédiques. Deux examinateurs indépendants ont extrait l'information sur la qualité des rapports, le risque de biais, les médicaments, les populations et groupes témoins, la durée des études, les scores de douleur et les conclusions des auteurs quant à l'efficacité au plan des scores de douleur. Résultats : Nous avons recensé 33 études orthopédiques, dont 21 études primaires et 12 revues. La ...

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Section: Methodologic Qualitymentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Reporting Qualitymentioning

confidence: 99%

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Cannabis for pain in orthopedics: a systematic review focusing on study methodology

Madden

George

Hoek

et al. 2019

cjs

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“…Three studies examined multiple cannabinoid doses, leading to a total of 11 cannabinoid intervention versus placebo comparisons. [32][33][34][35][36][37] Table 2 summarizes the route of administration utilized for the included studies. Oral cannabinoids were examined in 5/6 (83%) of the included studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three of these trials examined synthetic D 9 -tetrahydrocannabinol (THC) in the form of nabilone (2) and AZD1940 (1). 32,35,36 One study examined the effects of a synthetic CB2-selective agonist, GW842166. 37 One study examined a plant-based cannabis oil extract in capsule form.…”

Section: Study Characteristicsmentioning

confidence: 99%

Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis

Gazendam

Nucci

Gouveia

et al. 2020

Cannabis and Cannabinoid Research

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Objective: To synthesize the best evidence surrounding the efficacy of cannabinoids for acute pain in the clinical setting based on subjective pain scores and observed adverse effects. Design: Systematic review with meta-analysis. Data Sources: PubMed, Embase, Cochrane Databases, and Google Scholar. Eligibility Criteria: English-language randomized-controlled clinical trials comparing cannabinoids with placebo in patients with acute pain. Data Extraction and Synthesis: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of three reviewers. Data were pooled through meta-analysis and stratified by route of administration. Primary Outcomes and Measures: Patient-reported pain and adverse events (AEs). Results: Six trials (678 participants) were included examining oral (5 trials) and intramuscular (1 trial) cannabinoids. Overall, there was a small but statistically significant treatment effect favoring the use of cannabinoids over placebo (À0.90, 95% confidence interval [CI] À1.69 toÀ0.1, i 2 = 65%, p = 0.03). When stratified by route of administration, intramuscular cannabinoids were found to have a significant reduction in pain relative to placebo (À2.98, 95% CIÀ4.09 toÀ1.87, i 2 = 0%, p < 0.0001). No difference in effect was observed between oral cannabinoids and placebo (À0.21, 95% CI À0.64 to 0.22, i 2 = 3%, p = 0.34). Serious AEs were rare, and similar across the cannabinoid (14/374, 3.7%) and placebo groups (8/304, 2.6%). Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral. Higher quality, long-term randomized-controlled trials examining whether there may be a role for cannabinoids in treating acute pain are required.

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Surgery-Related Considerations in Treating People Who Use Cannabis

Mims,

Parikh,

Sandhu

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceCannabis use has experienced substantial growth. Many patients treated by otolaryngologists are using cannabis in various forms, often without the knowledge of the treating surgeon. These cannabinoid substances have various systemic effects, and it is critical for otolaryngologists to recognize how cannabis use may contribute to a patient’s care.ObservationsCannabis use has effects that contribute to every phase of a surgeon’s care. Preoperative counseling for tapering use may prevent increased rates of adverse effects. Care with anesthesia must be observed due to increased rates of myocardial ischemia, higher tolerance to standard doses, and prolonged sedation. Although results of studies are mixed, there may be an association with cannabis use and postoperative pain, nausea, and vomiting. Postoperative wound healing may be improved through the use of topical cannabinoids. Significant drug-drug interactions exist with cannabis, most notably with several common anticoagulant medications. Care should be exercised when managing medications for people who use cannabis. While many people who use cannabis consume it infrequently, a substantial population has developed cannabis use disorder, which is associated with increased morbidity and mortality postoperatively. Screening for cannabis use disorder is important and can be done through short screening tools.Conclusions and RelevancePatients who use cannabis may require special attention regarding preoperative counseling and workup, intraoperative anesthesia, postoperative pain management, nausea, wound healing, and drug-drug interactions. As patient use continues to increase, otolaryngologists will find an increasing need to remain up to date on how cannabis use contributes to patient care.

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A randomized-controlled trial of nabilone for the prevention of acute postoperative nausea and vomiting in elective surgery

Abstract: Oral nabilone 0.5 mg given as a single dose prior to surgery is ineffective in reducing PONV. This trial was registered at ClinicalTrials.gov, identifier: NCT02115529.

Cited by 48 publications

References 31 publications

Cannabis for pain in orthopedics: a systematic review focusing on study methodology

Cannabis for pain in orthopedics: a systematic review focusing on study methodology

Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis

Surgery-Related Considerations in Treating People Who Use Cannabis

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