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The Effect of Preoperative Cannabis Use on Postoperative Pain Following Gynaecologic Oncology Surgery

Published:February 21, 2022DOI:https://doi.org/10.1016/j.jogc.2022.01.018

      Abstract

      Objective

      To determine whether cannabis users have different pain scores after gynaecologic oncology surgery than non-cannabis users.

      Methods

      A retrospective chart review was completed for 654 patients who underwent gynaecologic oncology surgery during a 2-year period. The primary outcome was postoperative pain at 12 and 36 hours after surgery using an 11-point pain scale. Secondary outcomes included opioid consumption, length of hospital stay, opioid side effects, and sleep disturbance.

      Results

      Of all patients included in this study, 64 used cannabis and 590 did not. Propensity score matching and list-wise deletion identified 57 matched pairs. Pain scores were significantly higher at 12 hours (P < 0.001) and 36 hours (P =0.002) after surgery in cannabis users (median pain scores 6 [IQR 5–7]) and 5 [IQR 4–7], respectively) than non-users (median pain scores 4 [IQR 3–6] and 4 ([IQR 2–5], respectively). Median opioid consumption was significantly higher at 12 hours (P = 0.039) and 36 hours (P = 0.044) after surgery in cannabis users (oral morphine equivalent [OME] 20 [IQR 10–40] mg and OME 40 [IQR 10–100] mg, respectively) than non-users (OME 10 [IQR 5–20] mg and OME 30 mg [IQR 7.5–50] mg, respectively]. Sleep disturbance was significantly higher in cannabis users (odds ratio 3.31; P = 0.009).

      Conclusions

      After gynaecologic oncology surgery, patients who used cannabis preoperatively had higher postoperative pain scores, higher opioid use, and more sleep disturbance than non-users. This suggests that preoperative cannabis use is a risk factor for postoperative pain.

      Résumé

      Objectif

      Déterminer si les consommatrices de cannabis ont des scores de douleur après une intervention chirurgicale gynéco-oncologique différents de ceux des non-consommatrices.

      Méthodologie

      Un examen rétrospectif a été effectué sur les dossiers de 654 patientes ayant subi une intervention chirurgicale gynéco-oncologique au cours d’une période de 2 ans. Le critère de jugement principal était la douleur postopératoire à 12 et 36 heures post-intervention mesurée sur une échelle de douleur de 11 points. Les critères de jugement secondaires étaient la consommation d’opioïdes, la durée du séjour à l’hôpital, les effets indésirables des opioïdes et les troubles du sommeil.

      Résultats

      Cette étude inclut 64 consommatrices et 590 non-consommatrices de cannabis. La correspondance des scores de propension et la suppression des dossiers incomplets ont permis de former 57 paires appariées. Les scores de douleur étaient significativement plus élevés à 12 heures (p < 0,001) et à 36 heures (p = 0,002) post-intervention chez les consommatrices (scores de douleur médians respectifs : 6 [IIQ : 5-7]) et 5 [IIQ : 4-7]) que chez les non-consommatrices (scores de douleur médians respectifs : 4 [IIQ : 3-6] et 4 [IIQ : 2-5]). La consommation médiane d’opioïdes était significativement plus élevée à 12 heures (p = 0,039) et à 36 heures (p = 0,044) post-intervention chez les consommatrices (20 mg [IIQ : 10-40] en équivalent de morphine orale [EMO] et 40 mg [IIQ : 10-100] en EMO, respectivement) que chez les non-consommatrices (10 mg [IIQ : 5-20] en EMO et 30 mg [IIQ : 7,5-50] en EMO, respectivement). Les troubles du sommeil étaient significativement plus élevés chez les consommatrices de cannabis (rapport de cotes : 3,31; p = 0,009).

      Conclusions

      Après une intervention chirurgicale gynéco-oncologique, les patientes ayant consommé du cannabis avant l’intervention avaient un score de douleur postopératoire plus élevé, une consommation plus élevée d’opioïdes et plus de troubles du sommeil comparativement aux non-consommatrices. Ces observations indiquent que la consommation préopératoire de cannabis est un facteur de risque de la douleur postopératoire.

      Keywords

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