Understanding cannabis’s impact on surgery recovery

Cannabis use is increasingly common among older adults, often for medical reasons like chronic pain. But how does this trend affect postoperative recovery? A new study from the University of Florida sheds light on this pressing question, showing that cannabis use is linked to worse pain outcomes and increased opioid requirements after surgery.

Key findings at a glance

• Study type: Propensity-matched retrospective cohort study
  
• Population: 504 patients aged ≥65 years undergoing major inpatient surgery
  
• Exposure: Cannabis use within 60 days prior to surgery
  
• Outcomes:
  
  • Higher average postoperative pain scores (DVPRS)
    
  • Increased total oral morphine equivalents (OME)
    
• Timeframe assessed: First 24 hours after surgery
  

What the study found

Increased pain and opioid needs

Compared to non-users, cannabis users experienced significantly more pain and required higher doses of opioids:

• Pain score (DVPRS):
  
  • Cannabis users: 4.68 (IQR: 2.71–5.96)
    
  • Non-users: 3.88 (IQR: 2.33–5.17)
    
  • Median difference: 0.80 (p=0.01)
    
• Opioid use (OME):
  
  • Cannabis users: 42.50 mg (IQR: 15.00–60.00)
    
  • Non-users: 30.00 mg (IQR: 7.50–60.00)
    
  • Median difference: 12.5 mg (p=0.02)
    

On average, cannabis users were 58% to 71% more likely to experience moderate-to-severe pain than non-users, even after adjusting for opioid dosage.

Clinical and policy implications

What this means for healthcare

• Pain management should be personalized for older adults with a cannabis use history.
  
• Preoperative screening for cannabis use should become routine.
  
• Providers should anticipate the potential need for higher opioid dosages or multimodal analgesia strategies.
  

The ASRA-PM (American Society of Regional Anesthesia and Pain Medicine) guidelines recommend multimodal approaches for cannabis users, reserving opioids as rescue therapy.

Conclusion

This landmark study adds to a growing body of evidence suggesting that cannabis use before surgery may lead to higher postoperative pain and opioid requirements, especially in older adults.

Reference: Sajdeya R et al. Cannabis use and acute postoperative pain outcomes in older adults: a propensity matched retrospective cohort study. Regional Anesthesia & Pain Medicine 2025;50:771-778.

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