Tags: cannabis, orthopedic surgery, perioperative, postoperative, elective procedures

 

Thumbnail: This study looked at risks and effects of cannabis when used for the management of orthopedic pain. Reviewing available literature, this study looked at the related risks and benefits of different modes of administration. It found that edible and topical cannabis products had fewer side effects than inhaled cannabis products, and suggested that topical cannabis may be beneficial for wound healing.

 

The problem: Cannabis is one of the most commonly used recreational drugs and is becoming more commonly used for medicinal purposes. One example is the increasing popularity of cannabis among orthopedic patients, to better manage musculoskeletal pain. Given this popularity, it is important for healthcare professionals to understand the risks and benefits associated with its use.

 

The study: In this study, the authors reviewed the current literature regarding different modes of cannabis administration and their related risks and potential benefits; specifically with regard to perioperative and postoperative use with elective orthopedic procedures.

 

Main Points:

• Inhaled cannabis

  • Most direct route of consumption

  • • Carcinogen exposure

    • Uvulitis

    • Airway edema

    • Cardiac abnormalities/myocardial infarction

    • Prolonged sedative effects of general anesthesia

• Ingested cannabis

  • Acts more slowly and results in lower blood concentrations (approx 25% lower) compared to inhalation

  • • Effects from inaccurate labeling, including difficulty maintaining dosing regimen

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• Topical cannabis

  • Blood levels of THC/CBD are lower than those after inhalation, similar to those after ingestion

  • Risks associated with topical cannabis:

    • Effects from inaccurate labeling, including difficulty maintaining dosing regimen

• Cannabis may change a patient’s reaction to and/or metabolism of certain medications or substances, which can affect perioperative and postoperative medication regimens

• Some studies suggest that cannabis may have an effect on clotting, but more studies are needed to be sure

• The CBD in topical cannabis may aid in wound healing after surgery, but more studies are needed to better define the risks/benefits of this

• Cannabis may be an alternative for pain management for surgical patients, and may help reduce opiod use

• An accurate and detailed history of cannabis use, taken before surgery, should be discussed prior to anesthesia to help healthcare professionals to manage risks

 

Conclusions: There are both potential therapeutic benefits and significant risks to the use of cannabis, with regard to elective orthopedic surgeries. Edible and topical cannabis products seem to have a lower side effect profile, compared to inhaled cannabis; however, more, larger, studies are needed to further determine the efficacy, safety, and side effect profile of cannabis.

 

Why this is a good study:

• This study reviewed both and studies to provide suggested directions for further studies

• This study offers suggestions for how healthcare professionals can prepare and mitigate potential risks associated with cannabis use

 

Why this isn’t a perfect study:

• This study offers only general suggestions about what benefits there may be for cannabis use, relative to elective orthopedic surgery. However, this may be a result of a lack of robust clinical studies and available literature.

 

What this study adds:

• This study consolidates existing information on the risks/benefits of cannabis use, relative to elective orthopedic surgery

• It also shows that more evidence is needed to fully understand the effects of cannabis use on orthopedic surgery and suggests some potential avenues of study

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What it doesn’t:

• The authors were unable to draw concrete associations between cannabis use and benefits related to orthopedic surgery

• This study does not add any new data about the risks or benefits of cannabis use in this context

 

Funder: None stated

 

Author conflicts: None stated