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

Reg Anesth Pain Med. 2023 Mar;48(3):97-117. doi: 10.1136/rapm-2022-104013. Epub 2023 Jan 3.


Background: The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.

Methods: In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.

Results: Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.

Conclusions: Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.

Keywords: acute pain; ambulatory care; analgesics, opioid; obstetrics.

MeSH terms

  • Analgesics / therapeutic use
  • Cannabinoid Receptor Agonists
  • Cannabinoids* / adverse effects
  • Cannabis*
  • Humans
  • Pain / drug therapy
  • Pain Management / adverse effects


  • Cannabinoids
  • Analgesics
  • Cannabinoid Receptor Agonists