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Effects of nabilone, a synthetic cannabinoid, on postoperative pain

[Les effets de la nabilone, un cannabinoïde synthétique, sur la douleur postopératoire]

From the Departments of Anesthesiology and Pharmacology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.

Address correspondence to: Dr. Pierre Beaulieu, Department of Anesthesiology, CHUM – Hôtel-Dieu, 3840 rue St-Urbain, Montréal, Québec H2W 1T8, Canada. Phone: 514-343-6338; Fax: 514-412-7222; E-mail: pierre.beaulieu{at}umontreal.ca

Purpose: Cannabinoids have been shown to have analgesic properties in animal studies, but a potential role for these drugs in acute pain management has not been established. It was hypothesized that nabilone, an oral cannabinoid synthetic tetrahydrocannabinol analogue, decreases morphine consumption, pain scores, nausea and vomiting following major surgery.

Methods: A double-blind, randomized, placebo-controlled, parallel-group pilot trial compared the effects of two different doses, 1 mg (n = 11) and 2 mg (n = 9) of nabilone, ketoprofen 50 mg (n = 11) or placebo (n = 10), given at eight-hour intervals for 24 hr. Outcomes included morphine consumption, pain scores and emesis after major surgery. Secondary outcomes included patient tolerability of the study medication.

Results: Forty-one patients (mean age 52 ± 2 yr) undergoing gynecologic (46%), orthopedic (44%), or other (10%) surgery were recruited. Cumulative 24-hr morphine consumption was not different between the four groups, but pain scores at rest and on movement were significantly higher in the 2 mg nabilone group compared to the other groups. There were no significant differences between groups with respect to episodes of nausea and vomiting, quality of sleep, sedation, euphoria, pruritus, or the number and severity of adverse events. No serious adverse event was recorded.

Conclusions: Contrary to the main hypothesis, high dose nabilone in the presence of morphine patient controlled analgesia is associated with an increase in pain scores in patients undergoing major surgery.

Related articles in CJA:

Cannabinoids and pain management/Les cannabinoïdes et le contrôle de la douleur

Orlando Hung, Mary E. Lynch, and Alexander J. Clark
CJA 2006 53: 743-746. [Full Text]  

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