Wednesday Sep 13, 2023

Episode 18: ASRA Pain Medicine Guidelines on the Management of the Perioperative Patient on Cannabis

The political, professional, and cultural implications of using cannabinoids remain controversial despite its increased prevalence over the last 20 years. The American Society of Regional Anesthesia and Pain Medicine established a working group in November 2020 to review the evidence and knowledge gaps around cannabis use in the perioperative period and develop clinical recommendations for the management of patients using cannabis in this setting.


Authors Shalini Shah, MD, MBA, and Hance Clarke, MD, FRCPC, PhD, joined RAPM Editor-in-Chief Brian Sites, MD, to discuss committee’s findings, which were published in the article “ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids” in January 2023 (


The committee used a Delphi method with > 75% consensus to answer nine clinical questions. The members concluded that all surgical patients should be screened for cannabinoid use prior to surgery, heavy users be counseled on the negative effects on postoperative pain control, and surgery be postponed for patients who present with acute cannabis intoxication. They also advised that pregnant patients be educated on the risks of maternal cannabis on the fetus/neonate.


Dr. Shalini Shah is a professor and vice chair for the department of anesthesiology and director of perioperative services at the University of California at Irvine School of Medicine. She completed her residency in anesthesiology from Cornell University and a combined fellowship in adult and pediatric chronic pain at Harvard Medical School. She is the founder of the Pediatric Pain Program at UC Irvine and has previously served as associate program director for the pain medicine fellowship. Dr. Shah is the recipient of the ASRA Pain Medicine Chronic Pain Research Grant Award in 2017 for her landmark work in onabotulinumtoxinA (BOTOX®) use in pediatric migraine pain.


Dr. Hance Clarke is the director of pain services and the pain research unit at the Toronto General Hospital in Toronto, Canada. He is the knowledge translation chair for the University of Toronto Centre for the Study of Pain and an associate professor in the department of anesthesiology and pain medicine at the University of Toronto. Dr. Clarke has authored more than 150 peer-reviewed publications and has been invited to speak on pain control, cannabis, and the opioid crisis to the House of Commons in Ottawa, Canada, and elsewhere around the world.


*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.


Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

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