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Canadian Journal of Anesthesia 54:155 (2007)
© Canadian Anesthesiologists' Society, 2007

Correspondence

Cannabinoids for postoperative analgesia?

Étienne de Médicis, MD MSc FRCPC and Jean-Pierre Tétrault, MD MSc FRCPC

Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada, E-mail: estria1{at}globetrotter.net

To the Editor:

We read with interest the article on the effects of nabilone on postoperative pain by Pierre Beaulieu.1 While it is unfortunate that his results did not generate firm conclusions, we believe that descriptive subgroup analyses may have yielded some important information regarding the effects of nabilone on postoperative morphine consumption and side-effects. Nineteen of the 41 patients in the study underwent hysterectomy or myomectomy, which is a surgically homogenous patient population for whom it would have been interesting to have compared the effects of placebo, ketoprofen and nabilone doses of 1 and 2 mg on morphine consumption, visual analogue scale (VAS) scores and secondary outcomes. Eighteen of the 41 patients underwent orthopedic surgery (hip or knee arthroplasty), which represents a different surgical population of potentially greater heterogeneity, with an additional confounding factor that knee arthroplasties are associated with more postoperative pain compared with hip arthroplasty.2 A greater number of knee arthroplasty patients in the nabilone 2 mg group could explain why there is an apparent possible hyperalgesic effect of nabilone. Hence, it would be interesting to know the breakdown of knee/hip arthroplasty by study group (placebo, ketoprofen and nabilone 1 and 2 mg), and the results (morphine consumption, VAS scores and secondary outcomes) according to the orthopedic procedure and study group.

Footnotes

Accepted for publication November 6, 2006.

References

1 Beaulieu P. Effects of nabilone, a synthetic cannabinoid, on postoperative pain. Can J Anesth 2006; 53: 769–75.[Abstract/Free Full Text]

2 Pang WW, Hsu TC, Tung CC, Hung CP, Chang DP, Huang MH. Is total knee replacement more painful than total hip replacement? Acta Anaesthesiol Sin 2000; 38: 143–8.[Medline]


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