Cannabinoids for Postoperative Pain After Orthopedic Surgery: A Scoping Review of Clinical Evidence

Background and/or Objectives: The management of postoperative pain in orthopedic surgery remains a significant clinical challenge, particularly in the context of growing concerns over opioid dependence. Cannabinoid-based therapies, including cannabidiol (CBD), tetrahydrocannabinol (THC), and combined formulations, have emerged as potential alternatives or adjuncts to traditional analgesics. This scoping review aims to systematically evaluate experimental evidence from the past decade regarding the safety, efficacy, and opioid-sparing effects of cannabinoids in the postoperative setting for orthopedic procedures.

Design: Scoping review conducted using the Arksey and O’Malley framework and reported in accordance with PRISMA-ScR guidelines.

Setting : Peer-reviewed experimental studies conducted in clinical inpatient or surgical recovery settings.

Participants : Adult patients (≥18 years) undergoing orthopedic surgical procedures such as joint arthroplasty, fracture repair, or spine surgery.

Interventions: Cannabinoid-based therapies including CBD-only, THC-only, or CBD/THC combination products for post-operative pain.

Main Outcome Measures: Pain intensity (e.g., visual analog scale or numerical rating scale), postoperative opioid consumption, hospital length of stay, functional outcomes, and incidence of cannabinoid-related adverse events.

Results: Thirteen studies met inclusion criteria (4 CBD-only, 8 CBD/THC combination, 1 THC-only). CBD-only studies showed mixed results; some demonstrated modest reductions in opioid use, while others reported no significant analgesic benefit. Combined CBD/THC formulations showed neutral to modest improvements in pain and opioid-sparing effects without major adverse events. The sole THC-only study reported increased opioid consumption and prolonged length of stay, though confounded by comorbid substance use. Across studies, heterogeneity in cannabinoid composition, dosing, and outcome measures limited generalizability.

Conclusions: Preliminary evidence suggests that cannabinoids, particularly CBD/THC combinations, may offer modest opioid-sparing benefits in orthopedic post-operative care. However, inconsistent formulations, lack of dosing standardization, and variable study design hinder definitive conclusions. Further randomized trials with standardized cannabinoid profiles and functional endpoints are needed to establish efficacy, safety, and optimal use parameters for post-surgical pain management in orthopedic populations.