CBD and Anesthesia: Guidelines for Pausing Use Before and After Surgery

Medical professionals commonly recommend refraining from CBD and other cannabis products immediately before and after surgical procedures. This advice stems from the current lack of comprehensive research on how these substances may impact surgical safety and recovery.

Cannabidiol (CBD), a key compound in cannabis, is frequently used to alleviate:

• pain
• nausea and vomiting
• anxiety and stress

While research into CBD's therapeutic benefits and risks is ongoing, the only FDA-approved CBD medication is Epidiolex, prescribed for rare epilepsy-related seizures.

Studies exploring CBD's influence on anesthesia and surgery outcomes remain scarce. Evidence indicates that cannabis smokers might require increased anesthesia doses compared to non-users, but data specifically on CBD's effects with anesthesia is minimal.

Is It Necessary to Stop CBD and Cannabis Before Surgery?

Most healthcare experts suggest avoiding cannabis products for several hours to days prior to surgery due to uncertain effects on surgical outcomes and possible interactions with anesthesia or medications.

A 2022 study found that patients using cannabis before surgery experienced:

• increased postoperative pain
• greater opioid consumption
• more sleep disruptions

Impact of Cannabis on Surgical Procedures

Research predominantly focuses on smoked cannabis, with limited data on other forms. The American Society of Anesthesiologists (ASA) advises against smoking cannabis on the day of surgery and recommends waiting at least two hours after last use before elective procedures. This is due to findings that:

• Cannabis smoking can elevate heart rate and blood pressure for up to two hours, increasing the risk of heart complications during surgery.
• Smoking cannabis within two hours of surgery poses higher risks than smoking earlier, though any recent use may still have some impact.
• Frequent cannabis use the day before surgery might negatively affect outcomes.

The American Society of Regional Anesthesia and Pain Medicine recommends screening all surgical patients for cannabis use.

Potential Interactions Between CBD, Medications, and Anesthesia

Ongoing research is examining whether CBD interacts with other drugs, particularly those metabolized by liver enzymes CYP3A4 and CYP2C19. Such interactions could influence anesthesia or medication effectiveness.

Preliminary studies hint at possible interactions between CBD, THC, and blood thinners like warfarin, potentially increasing bleeding risk.

For more on CBD drug interactions, consult healthcare resources.

Recommended Duration to Stop CBD Before Surgery

No formal guidelines exist for when to discontinue CBD before surgery, but many experts advise stopping several days prior to reduce risks.

The American College of Surgeons suggests ceasing cannabis products at least 72 hours before surgery.

The ASA cautions against abruptly stopping Epidiolex, a CBD-based medication used for seizure control, without medical advice.

CBD’s half-life ranges from 27 to 35 hours, meaning it typically takes about 4.5 to 7 days for the compound to be largely eliminated from the body.

Post-Surgery CBD Use: What You Should Know

There is no consensus on whether to avoid CBD after surgery or for how long. Discuss with your surgeon to determine the safest approach.

Research on CBD’s effectiveness for surgical pain is mixed. A 2024 study in the Orthopaedic Journal of Sports Medicine found no significant difference in recovery between CBD users and placebo groups, though CBD may help with pain.

The International Association for the Study of Pain notes insufficient evidence supporting cannabinoids for acute surgical pain, though they might benefit chronic pain management.

A 2023 review in The Journal of Pain questions CBD’s pain relief efficacy and raises concerns about product purity.

Common Questions About CBD, Anesthesia, and Surgery

Below are frequently asked questions regarding CBD use around surgery.

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When to Disclose CBD Use to Your Doctor

Always inform your anesthesiologist about recent cannabis or CBD consumption before surgery, as this may influence anesthesia management.

Does CBD Cause Sedation?

While CBD can promote relaxation, its sedative effects are mild and not fully understood in surgical contexts. Avoid using CBD before surgery until safety is established.

CBD Use Before Colonoscopy

Discuss CBD use with your physician prior to a colonoscopy to ensure it is safe and will not affect sedation or procedure outcomes.

CBD for Postoperative Pain Relief

Anecdotal reports suggest CBD might help with pain after surgery, but robust clinical evidence is lacking.

Summary

Due to limited research on CBD’s safety around surgery, it is crucial to inform your surgeon about any cannabis product use. Potential interactions with medications and anesthesia underscore the importance of medical guidance.

CBD products may also vary in quality and labeling, which can pose additional risks during surgical care.

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