Summary of "ASRA Pain Medicine Consensus Guidelines on the Management of the Perioperative Patient on Cannabis and Cannabinoids"

Summary published April 5, 2023

Summary by Brian Thomas, JD

Regional Anesthesia & Pain Medicine | January 2023

Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. 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. PMID: 36596580.


  • In response to the increasing legalization and use of both medicinal and recreational cannabis in the United States, the American Society of Regional Anesthesia (ASRA) and Pain Medicine created a steering committee to develop evidence-based guidelines for anesthesia and perioperative professionals to manage patients taking cannabinoids in light of the effects and interactions these substances can have on anesthetic medications, opioids, and pain.
  • The steering committee was comprised of 13 experts, including anesthesiologists, chronic pain physicians, and a patient advocate.
    • This study utilized a modified Delphi method for committee members to vote on recommendations. Recommendation grades were based on the US Preventative Services Task Force (USPSTF) definitions of evidence of strength.
    • The committee responded to nine questions and made 21 recommendations with ≥75% agreement needed to reach consensus for each recommendation.
  • The first recommendation is that a universal screening for cannabis and cannabinoid users should be performed prior to surgery, taking into consideration the type of cannabinoid product used, route of administration, typical frequency and amount used, and most recent consumption.
  • These are the first U.S.-based guidelines for perioperative management of cannabis and were developed to assist anesthesia and perioperative professionals in managing the significant potential negative medical implications of cannabis and cannabinoid use in the perioperative setting in the pursuit of optimal patient care.