A randomized clinical trial published today found that patients given a moderate dose of cannabidiol (CBD) following bilateral knee replacement surgery used fewer opioids and reported less pain than those receiving a placebo.
The study, published October 22 in The Journal of Pain, was conducted by researchers from the Hospital for Special Surgery and Weill Cornell Medicine in New York City. It examined whether pharmaceutical-grade CBD could improve postoperative pain management and reduce reliance on opioid medications.
Researchers enrolled 36 adults undergoing bilateral total knee arthroplasty, a procedure replacing both knee joints. Participants were randomly assigned to three groups of 12, receiving either a placebo, 400 milligrams of CBD or 800 milligrams of CBD. Each participant received four doses during the surgical treatment period, alongside standardized anesthesia and conventional pain medications.
Over the first 72 hours following surgery, patients in the 400-milligram group consumed an average of 144 morphine milligram equivalents (MME) of opioids, compared with 209 MME in the placebo group. That represents approximately 31% less opioid consumption.
Patients receiving the moderate CBD dose also reported lower pain scores and required fewer additional rescue pain medications, although they used more nonsteroidal anti-inflammatory drugs than the placebo group.
The higher CBD dose did not produce comparable benefits. Patients receiving 800 milligrams consumed approximately 203 MME of opioids, nearly identical to the placebo group’s consumption, and experienced more adverse effects.
Researchers also examined sleep, mood, inflammation and CBD concentrations in the bloodstream. Participants receiving CBD reported improvements in certain aspects of sleep, although objective sleep measurements did not show corresponding benefits. Anxiety and depression scores were higher among CBD recipients, particularly those receiving 800 milligrams, while levels of the inflammatory marker interleukin-6 were also elevated.
The researchers used Epidiolex, a prescription CBD oral solution approved by the U.S. Food and Drug Administration for certain seizure disorders. Its use for postoperative pain management remains investigational.
The study, titled Effects of Cannabidiol (CBD) Oral Solution in Patients Undergoing Bilateral Total Knee Arthroplasty: A Randomized, Controlled, Parallel, Triple Blind, Pilot Study, is available online ahead of its final journal publication.
