Cannabis use increases pain after surgery

— Adults who use cannabis experience more pain after surgery than those who do not use cannabis, according to a study presented at the ANESTHESIOLOGY® 2022 annual meeting.

“Cannabis is the most commonly used illicit drug in the United States and increasingly used as an alternative treatment for chronic pain, but there is little data that shows how it affects patient outcomes after surgery,” said said Elyad Ekrami, MD, lead author of the study. Clinical Research and Study Fellow in the Department of Outcomes Research, Institute of Anesthesiology, Cleveland Clinic. “Our study shows that adults who use cannabis experience more—not less—postoperative pain. Therefore, they have higher opioid consumption after surgery.

The researchers analyzed the records of 34,521 adult patients – including 1,681 cannabis users – who underwent elective surgeries at the Cleveland Clinic from January 2010 to December 2020. The cannabis users had used the drug in the 30 days prior to the surgery, while the other patients had never used cannabis. . Patients who used cannabis experienced 14% more pain in the first 24 hours after surgery compared to patients who never used cannabis. Additionally, patients who used cannabis consumed 7% more opioids after surgery, which the authors say was not statistically significant, but is likely clinically relevant.

“The association between cannabis use, pain scores, and opioid use has been reported before in smaller studies, but they have had conflicting results,” Dr. Ekrami added. “Our study has a much larger sample size and does not include patients with chronic pain or those who received regional anesthesia, which would have seriously contradicted our results. In addition, our study groups were balanced by confounding factors such as age, gender, smoking and use of other illicit drugs, as well as depression and psychological disorders.

Dr. Ekrami noted that more research is needed to better define the effects of cannabis on surgical outcomes. “Physicians should consider that patients using cannabis may experience more pain and require slightly higher doses of opioids after surgery, underscoring the need to continue exploring a multimodal approach to post-surgical pain control,” did he declare.


Founded in 1905, the American Society of Anesthesiologists (ASA) is a teaching, research, and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. The ASA is committed to ensuring that physician anesthesiologists assess and supervise patients’ medical care before, during, and after surgery to provide the highest quality and safest care that every patient deserves.

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