A recent study examined the effects of utilizing perioperative dronabinol, a synthetic tetrahydrocannabinol agent, for patients who undergo total knee arthroplasty (TKA). Although previous studies conclude that this FDA-approved agent is beneficial to those experiencing chemotherapy-induced symptoms and patients suffering from HIV or AIDS, there is lacking evidence and trials on its effects on analgesic efficacy in acute and postoperative pain.
Using two groups of participants in a randomized, placebo-controlled trial, researchers at the Hospital for Special Surgery in New York, NY, examined the potential role of perioperative cannabinoids for pain management and opioid reduction for patients of TKA. Postoperative pain management following TKA can be managed while the patient is still under hospital care with the use of anesthesia techniques; however, the resurgence of pain during postoperative day (POD) 2 is typically managed with opioids.
The primary outcome was opioid consumption 24-48 hours after surgery with additional outcomes such as pain during ambulation on POD 2, the number of oxygen desaturation events, and overall sleep quality for the TKA patient.
The placebo group received sesame oil capsules and the dronabinol group received 5mg active capsules. Both groups took the respective capsule twice a day, for a total of five doses. This began in the preoperative period and concluded on POD 2. Both groups were given a standardized pain management regimen during admission and a standard discharge opioid prescription. All participants wore two wrist devices in the post-anesthesia care unit to measure oxygen desaturation and sleep quality.
Concluding the study was the final sample size of 102 TKA patients who participated. Researchers reported a lower cumulative postoperative opioid use and decreased overall pain ratings for the dronabinol group, however, the difference was deemed not statistically significant between the groups. Researchers found no statistically significant difference between the dronabinol group and the placebo group for desaturation events or sleep quality. Finalizing this study, dronabinol did not reduce opioid requirements following TKA during the 24-48 hour period.
The research abstract, “Effects of Perioperative Dronabinol Use in Total Knee Arthroplasty,” will be presented on March 21 at 1:30 pm PT, during the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in San Diego, CA. The abstract was selected as one of three “Best of Meeting Abstracts.” Authors include Pa Thor, Matthew Perlstein, Alex Illescas, Justas Lauzadis, Miriam Sheetz, Maya Tailor, Angela Puglisi, Marko Popovic, Joseph Oxendine, Yi Lin, Meghan Kirksey, Jacques Yadeau, Kanupriya Kumar, Lila Baaklini, Jiabin Liu, Stephanie Cheng, David Mayman, Seth Jerabek, Geoffrey Westrich, Fred Cushner, Michael Cross, Peter Sculco, Thomas Sculco, Michael Ast, Alejandro Gonzalez Della Valle, Alexandra Sideris, and Kethy Jules-Elysee.
ASRA Pain Medicine is a membership society of more than 5,000 health care professionals devoted to advancing evidence-based practice of pain medicine across the pain continuum, from acute pain to chronic pain. Our mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Our vision is to relieve the global burden of pain. We are committed to integrity, innovation, inclusiveness, service, compassion, and wellness. Learn more at www.asra.com.
