Perioperative cannabis use on postoperative pain in immediate alloplastic breast reconstruction

Cannabis use has increased substantially in recent years owing to changing legalization across the United States. This study evaluated its impact on postoperative pain and opioid consumption in patients undergoing mastectomy and alloplastic reconstruction.

A retrospective review was conducted on consecutive patients who underwent mastectomy with immediate bilateral tissue expander (TE) reconstruction between January 2021 and 2025. Patients were grouped as cannabis users or non-users. Postoperative opioid consumption and pain scores were assessed at 12-h intervals, and discharge opioid quantities and refill rates were recorded.

The study included 40 cannabis users and 197 non-users. Length of stay and complication rates were comparable between the groups. However, cannabis users reported significantly higher pain scores at 0-12 h (4.42 vs. 3.68, p = 0.018), 12-24 h (4.53 vs. 3.36, p = 0.004), and overall (4.46 vs. 3.53, p = 0.002). Opioid use was also higher at 0-12 h (29.55 vs. 19.73 MME, p = 0.001), 12-24 h (26.09 vs. 15.35 MME, p = 0.038), and cumulatively (67.40 vs. 44.38 MME, p = 0.010). Although discharge quantities were similar, cannabis users had more refill requests (42.5% vs. 22.8%, p = 0.017). On multivariable regression, cannabis use was not an independent predictor of inpatient or outpatient opioid use. Moreover, it showed a non-significant trend toward higher odds of refill requests (OR = 2.56, 95% CI 0.92-7.34, p = 0.073).

Cannabis use was associated with higher postoperative pain and opioid use on unadjusted analyses but was not an independent predictor after adjustment for confounders. These findings indicate that cannabis use may be a marker of increased analgesic requirement and support individualized perioperative pain management.