Question 1: Should all surgical and procedural patients requiring anesthesia be screened for cannabinoids preoperatively and if so, what information should be obtained?

Question 2: What evidence exists to guide the decision to continue or stop cannabinoids perioperatively and/or postpone elective surgery?

Question 3: For patients on concomitant cannabis and opioid use preoperatively, does existing evidence provide guidance on tapering of cannabinoids prior to surgery?

Question 4: What are the specific concerns of chronic cannabinoid use in a parturient presenting for labor or cesarean section?

Question 5: Should the intraoperative doses of anesthetics and analgesics be adjusted in patients who have taken cannabinoids preoperatively?

Question 6: Does acute or chronic cannabis exposure require any adjustment of ventilator settings to accommodate for possible V/Q mismatch, smoke inhalation injury, or other lung pathology?

Question 7: Do patients taking perioperative cannabinoids require any special postoperative considerations? If so, for how long?

Question 8: Are there special considerations for concomitant opioid and cannabinoid use and should postoperative opioid prescriptions be adjusted prior to discharge?

Question 9: How do cannabis withdrawal symptoms present in the postoperative period and is there evidence for specific treatment?

Document Overview

Design and created by Guideline Central in participation with the American Society of Regional Anesthesia and Pain Medicine.

Management of the Perioperative Patient on Cannabis and Cannabinoids

American Society of Regional Anesthesia and Pain Medicine

Publication Date: Jan 2, 2023

Page Last Updated: May 5, 2026

American Society of Regional Anesthesia & Pain Medicine Grading System

Certainty of the Evidence
Grade	Definition
High	Very confident that the true effect lies close to that of the estimate of the effect.
Moderate	Moderately confident in the effect estimate. The true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.
Low	Confidence in the estimate is limited. The true effect may be substantially different from the estimate of effect.
Very low	Very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

Document Overview

Document Title: Management of the Perioperative Patient on Cannabis and Cannabinoids

Authoring Society: American Society of Regional Anesthesia and Pain Medicine

Document Publication Date: Jan 2, 2023

Page Last Reviewed/Updated: May 5, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: rapm.bmj.com/content/early/2023/01/05/rapm-2022-104013

Source Citation: 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 Jan 3:rapm-2022-104013. doi: 10.1136/rapm-2022-104013. Epub ahead of print. PMID: 36596580.

Supplemental Implementation Resources

Visual Abstract

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Management, Prevention

Diseases/Conditions (MeSH)

D019990 - Perioperative Care

D002188 - Cannabis

D002186 - Cannabinoids

D019990 - Perioperative Care

D002188 - Cannabis

D002186 - Cannabinoids

Keywords: CBD, cannabinoids, cannabis, marijuana, perioperative, perioperative care, perioperative management

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Operating and Recovery Room, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Data Supplement Data Supplement Data Supplement Data Supplement

Number of Source Documents: 308

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: No

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Grades of Recommendation
A	Good evidence for or against recommending intervention
B	Fair evidence for or against recommending intervention
C	Poor quality evidence for or against recommending intervention
D	Weak quality evidence for or against recommending intervention
I	Insufficient or conflicting evidence not allowing a recommendation for or against intervention