ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Shah, Shalini; Schwenk, Eric S.; Sondekoppam, Rakesh V.; Clarke, Hance; Zakowski, Mark; Rzasa-Lynn, Rachel S; Yeung, Brent; Nicholson, Kate; Schwartz, Gary S.; Hooten, W Michael; Wallace, Mark; Viscusi, Eugene R.; Narouze, Samer

doi:10.1136/rapm-2022-104013

Cited by 49 publications

(78 citation statements)

References 282 publications

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“…A 12-member expert panel consisting of anesthesiologists, pain physicians, and a patient advocate used a modified Delphi method to create responses. Selected recommendations from these guidelines1 are shown in this infographic.…”

Section: Discussionmentioning

confidence: 99%

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids: an infographic

Shah

Schwenk

Narouze

2023

Reg Anesth Pain Med

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Section: Discussionmentioning

confidence: 99%

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids: an infographic

Shah

Schwenk

Narouze

2023

Reg Anesth Pain Med

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“…In the second round, the statements and recommendations with a predefined agreement greater than 75% were accepted. This threshold was used in another ASRA Pain Medicine consensus guideline . The subsequent draft was shared with all of the collaborators for final approval.…”

Section: Methodsmentioning

confidence: 99%

“…This threshold was used in another ASRA Pain Medicine consensus guideline. 14 The subsequent draft was shared with all of the collaborators for final approval.…”

mentioning

confidence: 99%

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Uppal,

Russell,

Sondekoppam

et al. 2023

JAMA Netw Open

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ImportancePostdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures, such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis, and management of this condition is, however, currently lacking.ObjectiveTo fill the practice guidelines void and provide comprehensive information and patient-centric recommendations for preventing, diagnosing, and managing PDPH.Evidence ReviewWith input from committee members and stakeholders of 6 participating professional societies, 10 review questions that were deemed important for the prevention, diagnosis, and management of PDPH were developed. A literature search for each question was performed in MEDLINE on March 2, 2022. Additional relevant clinical trials, systematic reviews, and research studies published through March 2022 were also considered for practice guideline development and shared with collaborator groups. Each group submitted a structured narrative review along with recommendations that were rated according to the US Preventive Services Task Force grading of evidence. Collaborators were asked to vote anonymously on each recommendation using 2 rounds of a modified Delphi approach.FindingsAfter 2 rounds of electronic voting by a 21-member multidisciplinary collaborator team, 47 recommendations were generated to provide guidance on the risk factors for and the prevention, diagnosis, and management of PDPH, along with ratings for the strength and certainty of evidence. A 90% to 100% consensus was obtained for almost all recommendations. Several recommendations were rated as having moderate to low certainty. Opportunities for future research were identified.Conclusions and RelevanceResults of this consensus statement suggest that current approaches to the treatment and management of PDPH are not uniform due to the paucity of evidence. The practice guidelines, however, provide a framework for individual clinicians to assess PDPH risk, confirm the diagnosis, and adopt a systematic approach to its management.

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“…Despite the equivocal results, recognition of the increasing use of cannabis among surgical patients and its potential adverse effects have led to the development of consensus recommendations for the perioperative management of these patients. 17,18 To quantify the perioperative impact of cannabis use disorder more accurately, we performed a study using the most recently available national-level data, validated outcome measures, and robust methods to minimize confounding. We hypothesized that cannabis use disorder would be associated with an increased risk of perioperative morbidity and in-hospital mortality (primary composite outcome) after major elective, inpatient, noncardiac surgery.…”

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confidence: 99%

Cannabis Use Disorder and Perioperative Complications

2023

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ImportanceCannabis use is growing in the US and is increasingly perceived as harmless. However, the perioperative impact of cannabis use remains uncertain.ObjectiveTo assess whether cannabis use disorder is associated with increased morbidity and mortality after major elective, inpatient, noncardiac surgery.Design, Setting, and ParticipantsThis retrospective, population-based, matched cohort study used data from the National Inpatient Sample for adult patients aged 18 to 65 years who underwent major elective inpatient surgery (including cholecystectomy, colectomy, inguinal hernia repair, femoral hernia repair, mastectomy, lumpectomy, hip arthroplasty, knee arthroplasty, hysterectomy, spinal fusion, and vertebral discectomy) from January 2016 to December 2019. Data were analyzed from February to August 2022.ExposureCannabis use disorder, as defined by the presence of specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes.Main Outcome and MeasuresThe primary composite outcome was in-hospital mortality and 7 major perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure–related complications) based on ICD-10 discharge diagnosis codes. Propensity score matching was performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type.ResultsAmong 12 422 hospitalizations, a cohort of 6211 patients with cannabis use disorder (median age, 53 years [IQR, 44-59 years]; 3498 [56.32%] male) were matched with 6211 patients without cannabis use disorder for analysis. Cannabis use disorder was associated with an increased risk of perioperative morbidity and mortality compared with hospitalizations without cannabis use disorder in adjusted analysis (adjusted odds ratio, 1.19; 95% CI, 1.04-1.37; P = .01). The outcome occurred more frequently in the group with cannabis use disorder (480 [7.73%]) compared with the unexposed group (408 [6.57%]).Conclusions and RelevanceIn this cohort study, cannabis use disorder was associated with a modest increased risk of perioperative morbidity and mortality after major elective, inpatient, noncardiac surgery. In the context of increasing cannabis use rates, our findings support preoperative screening for cannabis use disorder as a component of perioperative risk stratification. However, further research is needed to quantify the perioperative impact of cannabis use by route and dosage and to inform recommendations for preoperative cannabis cessation.

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ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Cited by 49 publications

References 282 publications

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids: an infographic

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids: an infographic

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Cannabis Use Disorder and Perioperative Complications

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