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October 05, 2020
10/5/2020 2:00:00 PM - 10/5/2020 3:00:00 PM
Room Virtual
Cannabis Use Is Associated With Increased Intraoperative Anesthetic And Postoperative Opioid Consumption In Isolated Tibia Fracture Repair
Ian Holmen, M.D., Jeffrey P. Beach, B.S., Alex Kaizer, Ph.D., Ramakrishna Gumidyala, M.D.
University of Colorado, Aurora, Colorado, United States
Disclosures: I. Holmen: None. J.P. Beach: None. A. Kaizer: None. R. Gumidyala: None.
Background: In the United States there has been a significant increase in cannabis use. A small but growing body of literature suggests that cannabis use is associated with increased delivery of analgesics perioperatively. However, variations in inciting injuries, type of surgery, and patients with histories of chronic pain or opioid use make interpretation of prior results difficult. This is the first study to assess intraoperative anesthetic and postoperative pain management from a standard inciting injury and surgery. Methods: This is a retrospective chart review study. All patients who had unilateral tibia fractures and underwent open reduction and internal fixation (ORIF) with intramedullary nail (IMN) at the University of Colorado Hospital in Aurora, Colorado from 1/12015 to 11/30/2019 were included. Patients with poly trauma, chronic pain, or prior opioid use were excluded. Cannabis use was defined as any patient self-reporting any quantity of use prior to surgery. All perioperative analgesic, sedative medications received, and subjective pain scores reported by patients were abstracted from patient charts from beginning of surgery through patient discharge. Pain scores were reported as a standardized pain numeric rating scale (NRS, 0-10 scale). Results: There were 118 patients who underwent unilateral ORIF with IMN of the tibia after excluding or the above criteria. Prior cannabis use was reported in 25.4% of patients. Cannabis use was not associated with higher dose of induction propofol (p = 0.761), however, average volume of intraoperative sevoflurane was significantly higher among cannabis users (37.4ml vs 25.0ml, p = 0.023). Cannabis use was also associated with higher PACU pain scores (6.0 vs 4.8, p = 0.036) and initial inpatient pain scores (6.2 vs 5.0, p = 0.029). Average total hospitalization morphine milligram equivalents (MME) were significantly higher in the cannabis user group (305.0 MME vs 214.6 MME, p = 0.041). There was not a significant difference in time in OR, PACU, or inpatient between cannabis users and non-users. Conclusions: This study suggests that patients with prior cannabis use may require higher doses of intraoperative inhaled anesthetic and postoperative opioid, and have higher subjective pain scores post operatively.

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