Cannabis-associated hyperalgesia and reduced local anesthetic efficacy in oral surgery

# Clinical Summary

This article describes an atypical adverse effect observed in oral surgery patients: cannabis use is associated with heightened pain sensitivity and diminished response to local anesthetics during dental procedures. The proposed mechanism involves chronic cannabinoid-induced alterations in endogenous pain modulation pathways, leading to a state of hyperalgesia where patients experience exaggerated pain despite adequate anesthetic administration. This finding has direct implications for perioperative management, as standard local anesthetic dosing and techniques may prove insufficient in regular cannabis users, potentially compromising surgical outcomes and patient satisfaction. Clinicians performing oral surgery or other procedures should consider cannabis use history when assessing anesthetic requirements and may need to employ adjusted anesthetic strategies for these patients. Understanding cannabis-associated hyperalgesia is particularly relevant as cannabis legalization increases the prevalence of regular users presenting for surgical care, making this a practical consideration for perioperative planning and patient counseling.

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