Cannabinoids for Acute Pain Management: A Contemporary Scoping Review of Evidence, Mechanisms, and Clinical Implications.

Akman C.; Ucar A.; Inci O.; Unaldi M.; Erdem B.; Ozkaya B.; Yilmaz G.; Karcioglu O. · Current pharmaceutical design · 2026

**Background & Methods** This contemporary scoping review systematically searched six electronic databases (CENTRAL, PubMed/MEDLINE, ClinicalKey, EMBASE, CINAHL, BIOSIS) for literature published between January 2016 and April 2026 examining cannabinoid pharmacology, mechanisms of action, clinical efficacy, safety, and perioperative implications in acute and postoperative pain management. Two blinded reviewers independently screened records and charted data against predefined eligibility criteria, with narrative and tabular summaries of findings. **Key Findings** - Preclinical evidence demonstrates robust antinociceptive effects of cannabinoids through multiple receptor pathways; however, these findings have not reliably translated into human acute pain models, with metaanalytic data showing either no significant reduction in acute pain scores versus placebo or only small, clinically uncertain improvements. - The opioid-sparing effect, while promising in preclinical and chronic pain studies, has not been demonstrated for acute postoperative pain, with a notable exception: a 2024 randomized trial demonstrating 40% reduction in opioid requirements with perioperative dronabinol following cardiac surgery. - The 2023 American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus guidelines formalized 21 recommendations for perioperative cannabinoid management, acknowledging limited evidence for routine acute pain use. **Dosage & Administration** Perioperative dronabinol demonstrated opioid-sparing effects in cardiac surgery at unspecified doses. Otherwise, specific dosing regimens were not consistently reported across reviewed studies. **Safety & Adverse Effects** Non-serious adverse events were consistently more frequent with cannabinoids than placebo, including dizziness, nausea, and sedation. Serious adverse event data were not detailed in this summary. **Evidence Quality** The clinical evidence base for acute pain remains of low quality and insufficient to support routine cannabinoid use. The review identifies a critical translation gap between preclinical efficacy and human clinical outcomes. Well-designed, large randomized controlled trials targeting defined acute pain populations are urgently needed. Current evidence supports consideration of cannabinoids only as adjuncts in specific populations with careful patient selection, dose titration, and safety monitoring.

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