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Use of cannabinoids for acute postoperative pain
Uso de cannabinoides en el dolor agudo postoperatorio
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In each model, a single candidate moderator will be entered, corrected for the confounding factors associated with the development of PPCs as identified in the main logistic regression model. PPCs: postoperative pulmonary complications; ΔP: driving pressure; 4DPRR driving pressure multiplied by four plus respiratory rate; MP: mechanical power.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S.C. Serafini, S.N.T. Hemmes, A. Serpa Neto, M.J. Schultz, E. Tschernko, M. Gama de Abreu, G. Mazzinari, L. Ball" "autores" => array:9 [ 0 => array:2 [ "nombre" => "S.C." "apellidos" => "Serafini" ] 1 => array:2 [ "nombre" => "S.N.T." "apellidos" => "Hemmes" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Serpa Neto" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Schultz" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Tschernko" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Gama de Abreu" ] 6 => array:2 [ "nombre" => "G." 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Sanchis Veryser, J.M. Esparza Miñana, J.V. Català Ripoll" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C.A." "apellidos" => "Sanchis Veryser" "email" => array:1 [ 0 => "sanchis_carver@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.M." "apellidos" => "Esparza Miñana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.V." "apellidos" => "Català Ripoll" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Facultativo Anestesiología, Reanimación y Tratamiento del Dolor, Hospital de Manises, Manises, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Responsable del Servicio de Anestesiología y Unidad del Dolor, Instituto Musculoesquelético Europeo, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de cannabinoides en el dolor agudo postoperatorio" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In October 2021, Spain’s parliament - the Congress of Deputies - created a subcommittee for the regulation of medical cannabis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that was given the task of analysing European regulations on this topic in order to draw up a report on the use of cannabis for medical purposes. In June 2022, the subcommittee voted in favour of regulation, and asked the Spanish Medicines Agency (AEMPS) to prepare the report, which should have been ready by December 2022. The potential scope of application and complexity surrounding cannabinoids has led to a growing demand for a legal framework regulating their administration and sale and the urgent need for a reliable, valid conceptual and operational basis for the use of cannabinoids.</p><p id="par0010" class="elsevierStylePara elsevierViewall">First, the confusion surrounding the difference between cannabis and cannabinoids has major legal and therapeutic impacts. The cannabis plant contains more than one hundred cannabinoids, of which Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most common.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These cannabinoids are mostly extracted from the Cannabis sativa plant, although other plants, such as Echinacea purpurea, Echinacea angustifolia, Acmella oleracea, Helichrysum umbraculigerum, Radula marginate and Kava also contain lipophilic alkyl amides which are considered cannabinoids based on the resemblance of their chemical structure and their ability to interact with cannabinoid receptors.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The psychoactive effect is determined by the THC content, and depending on the concentration of 9-THC, the plant is classified as hemp (below 0.3%), or marijuana (over 0.3% THC).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Cannabinoids have shown effectiveness in the treatment of chemotherapy-induced nausea and vomiting,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> benign chronic pain and cancer pain,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> tics and muscle spasms,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and inflammatory bowel disease,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> among others. One of the main indications for cannabinoids is chronic, particularly neuropathic, pain,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> but its use in acute postoperative pain has been less widely studied. Given the upsurge of opioid-free anaesthesia - without prejudice to locoregional techniques - cannabinoids could, in principle, be an analgesic alternative in acute postoperative pain.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The growing number of studies on cannabinoids, the speed at which new drugs are being developed, and the proliferation of indications for their use has led to methodological differences in published studies because, among other reasons, different cannabis preparations with different active ingredients are analysed (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). This raises concerns about the reliability and validity of the conclusions reached.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and method</span><p id="par0025" class="elsevierStylePara elsevierViewall">For the purposes of this review on the use of cannabinoids in acute postoperative pain, we searched the Google Scholar, Clinical Trials, PubMed and Cochrane databases for studies relevant to the topic of interest. We restricted our search to clinical trials, systematic reviews and meta-analyses published between 1981 and 2022 and containing the keywords “cannabinoid”, “postoperative pain” and “acute pain”.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">We found only 2 recent meta-analyses in the databases. The first meta-analysis, published by Abdallah et al.,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> focuses on the study of acute postoperative pain, and includes 12 original research articles, of which 8 were randomized controlled trials and 4 were observational studies. Of the 924 patients enrolled in the 8 randomized trials, 470 received cannabinoids for acute postoperative analgesia and 454 were controls. The observational studies included a total of 4,259 patients, 373 were or had been users of cannabinoids, and 3,886 were assigned to the control arm. A wide variety of surgical procedures, including abdominal surgery, gynaecological surgery, orthopaedic surgery, and dental extractions in which cannabinoids were used to treat acute postoperative pain were analysed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The primary objective of this meta-analysis was to evaluate analgesic consumption, measured by the accumulated oral morphine equivalent consumption during the first 24 h, and to assess patient-perceived pain at rest measured on the visual analogue scale (VAS) at 24 postoperative hours.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The secondary objective was to calculate morphine consumption measured by postoperative oral accumulated morphine equivalents and to evaluate pain on the VAS during the patient’s stay in the post-anaesthesia care unit, and at 24 h and 48 postoperative hours. Finally, the authors evaluated patient-perceived satisfaction and quality of recovery using the quality of recovery (QoR) questionnaire, and also recorded adverse reactions.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, the authors found that the analgesic role of perioperative cannabinoids is limited, and no clinically significant benefits were observed when cannabinoids were added to other traditional systemic analgesics. Another important finding was that postoperative pain increased in a dose-dependent manner 12 h after surgery, and cannabinoids increased the likelihood of postoperative hypotension.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors suggest that their results may be due to the fact that acute postoperative pain is primarily nociceptive in nature while chronic pain is mainly neuropathic, and this may explain why cannabinoids have shown moderate efficacy in treating the latter type of pain. In conclusion, the trials published so far do not support the routine use of cannabinoids for the management of acute postoperative pain.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The meta-analysis published by Gazendam et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> included 6 clinical trials, and in this case observational studies were excluded. The study cohorts ranged in size from 30 to 340 subjects, giving an overall total of 678 patients. The primary objective was to collect mean pain scores measured on the 0–10 VAS for up to 24 postoperative hours and patient-reported adverse events. One of the included studies differed from the others insofar as it evaluated intramuscular administration of cannabinoids.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> When the results were stratified by route of administration, intramuscular cannabinoids vs placebo were found to significantly reduce pain, while oral cannabinoids vs placebo produced no significant effect. The authors suggest that these differences may be due to pharmacokinetics, which varies as a function of the route of absorption. Specifically, oral absorption is slow and variable and cannabinoids are subject to significant first-pass liver metabolism, which further reduces their bioavailability.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding adverse events, there was a significantly higher incidence of dizziness and hypotension in the cannabinoid group, but no significant differences in serious adverse effects were observed (nausea, sedation, drowsiness, dysphagia, and pharyngeal pain). Finally, this meta-analysis concludes that there is low-quality evidence that cannabinoids have a small, but statistically significant, effect on acute pain in the clinical setting.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Both meta-analyses assessed risk of bias in all included studies using the Cochrane risk of bias tool, and graded the quality of evidence using the GRADE approach. The evidence for pain reduction in the included trials was downgraded to 'low' due to serious risk of bias and inconsistency.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Cannabinoids can be classified into 3 types: endocannabinoids, synthetic cannabinoids, and phytocannabinoids. Endocannabinoids are molecules synthesized in the human body. Synthetic cannabinoids (sCB) are chemical compounds synthesized with the aim of modulating the endocannabinoid system and, for the most part, exhibit high affinity binding to the cannabinoid CB1 and CB2 receptors as full agonists/antagonists. Given the scant evidence on the effect of these cannabinoids, the appearance of effects different from those produced by endocannabinoids cannot be ruled out. Phytocannabinoids are compounds extracted from the hemp or cannabis plant. The best known are THC and CBD.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The endocannabinoid receptors CB1 and CB2 are G protein-coupled transmembrane receptors that modulate processes associated with neurological and hormonal functions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> CB1 receptors are found in the cortex (thalamus, medulla, periaqueductal gray matter, and descending pain pathways), the spinal cord (descending pain pathways, and dorsal horn), and, peripherally on primary afferent sensory neurons, where they outnumber the mu receptor, suggesting a potential mechanism for the modulation and treatment of neuropathic pain.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Neuropathic pain is difficult to treat effectively, and very few patients obtain a clinically relevant benefit from interventions.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> A multidisciplinary approach combining pharmacological interventions with physical or cognitive effects (or both) is currently recommended. Treatment of neuropathic pain does not differ significantly from that of other chronic pain conditions, insofar as only a small proportion of trial participants respond well to treatment.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Considering the poorly understood pathogenesis of chronic neuropathic pain syndromes, the complexity of symptom expression, and the absence of a therapeutic gold standard, the potential for manipulation of the cannabinoid system is an attractive option.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">CB2 receptors are found primarily in the spleen, macrophages, and Kupffer cells, suggesting that they are involved in immunomodulatory mechanisms. Some CB2 receptors are inducible in the dorsal horn following inflammation or injury (this activation could limit the acute inflammatory process contributing to nociceptor sensitisation).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The most common adverse effects reported in the studies reviewed include drowsiness, nausea, dizziness, euphoria, or dry mouth.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Most of our understanding of the long-term effects of cannabinoids is extrapolated from studies on chronic recreational use, i.e., addiction, cardiovascular and respiratory problems, cognitive alterations, and psychological disorders.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Most clinical trials (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) investigating this topic are observational studies on both recreational and therapeutic consumption and the use of cannabis in perioperative medicine. Some of the clinical trials reviewed included very small randomised samples, all focussed on different primary outcome measures and used different types of cannabinoid compounds for the treatment of acute postoperative pain, and none provided specific information on purity and the THC: CBD ratio.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In addition, the trials used different routes of administration, dosages, and administration frequency, and in all cases cannabinoids were administered in combination with other analgesics.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Conceptualization problems, which need to be resolved before an <span class="elsevierStyleItalic">ad hoc</span> theoretical framework can be constructed, and the heterogeneity of studies on the clinical use of cannabinoids in the treatment of acute postoperative pain are variables expressive of the lack of sufficient scientific evidence in this regard. Despite this, and after a detailed analysis of the literature, we can conclude that the role of drugs with cannabinoid compounds in the treatment of acute postoperative pain is, at present, very limited. In fact, the clinical trials reviewed do not support the use of these medications to control this type of pain, and even found that they are associated with a greater number of adverse effects, such as hypotension and dizziness.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have not received specific funding from agencies in the private public and nonprofit sectors.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">This work has not received any type of funding.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2260305" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1885935" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2260306" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1885934" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-06-26" "fechaAceptado" => "2023-11-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1885935" "palabras" => array:3 [ 0 => "Cannabinoid" 1 => "Postoperative pain" 2 => "Acute pain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1885934" "palabras" => array:3 [ 0 => "Cannabinoides" 1 => "Dolor postoperatorio" 2 => "Dolor agudo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases.The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions.Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las dudas acerca de la eficacia del cannabis medicinal en el tratamiento del dolor agudo postoperatorio están bien justificadas, al menos, a la vista de la información recogida en las bases de datos Google Scholar, Clinical Trials, PubMed y Cochrane. La confusión entre el cannabis y los cannabinoides genera efectos no sólo normativos sino también médicos. Pese a que los cannabinoides han demostrado su eficacia en el tratamiento de diversas patologías todavía no la han demostrado en el tratamiento del dolor agudo postoperatorio. El creciente número de estudios al respecto conlleva cierta esperanza en este sentido sin embargo la diversidad metodológica empleada lastra cualquier posibilidad de alcanzar hallazgos concluyentes. Dado el estado de la cuestión, este artículo no puede realizar una afirmación contundente a favor o en contra del papel de los fármacos con compuestos cannabinoides en el tratamiento del dolor agudo postoperatorio.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drug \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mechanism of action \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FDA approved indications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Common side effects \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Available formulations \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tradename \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">THC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Psychoactive cannabinoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cannabinoid CB1 and CB2 receptor agonist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chemotherapy-induced nausea and vomiting, and HIV/AIDS-related loss of appetite and weight loss. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness, drowsiness, euphoria, dry mouth, tachycardia, anxiety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral capsules, nasal spray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Marinol, Syndros \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nonpsychoactive cannabinoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acts on the cannabinoid receptors CB1 and CB2, GPR55, TRPV1 and5-HT1A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epilepsy, neuropathic pain secondary to multiple sclerosis, chronic cancer pain, anxiety disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nausea, drowsiness, changes in appetite and body weight, fatigue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral oil, oral capsules, oral solution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EpidiolexIn Spain, approved for the treatment of Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis in children over 2 years of age. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nabilone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Synthetic cannabinoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Synthetic THC analogue,cannabinoid CB1 receptor agonist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chemotherapy-induced nausea and vomiting refractory to other treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness, drowsiness, dry mouth, increased heart rate, sleep disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral capsules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cesamet, Canemes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nabiximol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cannabis plant extract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Partial cannabinoid CB1 and CB2 receptor agonist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spasticity in multiple sclerosis that has not responded to other treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness, drowsiness, dry mouth, fatigue, nausea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral spray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SativexIn Spain, indicated for the palliative treatment of limb stiffness and the improvement of motor functions in patients with multiple sclerosis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dronabinol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Synthetic cannabinoid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Synthetic THC analogue, cannabinoid CB1 receptor agonist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chemotherapy-induced nausea and vomiting, and HIV/AIDS-related loss of appetite and weight loss. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dizziness, drowsiness, dry mouth, increased heart rate, mood changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral capsules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Marinol \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3675507.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Active ingredients in cannabis preparations.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Title \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of study \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Main results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical Cannabidiol (CBD) After Total Knee Arthroplasty Does Not Decrease Pain or Opioid Use: A Prospective Randomized Double-Blinded Placebo-Controlled trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haffar et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomized double-blind, placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical use of cannabidiol (CBD), essential oil, or a combination of both after total knee arthroplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical CBD as an adjunct to multimodal analgesia did not reduce pain or opioid consumption, and did not improve sleep scores. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Effects of nabilone, a synthetic cannabinoid, on postoperative pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pierre Beaulieu<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Double-blind randomized placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compares the effects of 2 different doses of nabilone (1 mg and 2 mg), ketoprofen 50 mg, or placebo administered every 8 h for 24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cumulative 24 -h morphine consumption did not differ among groups, but pain scores at rest and on movement were significantly higher in the 2 mg nabilone group compared to the other groups. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evaluation of intramuscular levonantradol and placebo in acute postoperative pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jain et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Double-blind randomized placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A single intramuscular dose of 1.5, 2.0, 2.5, or 3.0 mg of levonantradol or placebo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The levonantradol group reported a significant decrease in pain intensity compared to the placebo group. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evaluation of the analgesic efficacy of AZD1940, a novel cannabinoid agonist, on post-operative pain after lower third molar surgical removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kalliomäki et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Double-blind randomized placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients received a single oral dose of AZD1940 800 μg, naproxen 500 mg, or placebo 1.5 h before surgery. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The CB1/CB2 receptor agonist AZD1940 did not reduce postoperative pain after lower third molar extraction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buccally Absorbed Cannabidiol Shows Significantly Superior Pain Control and Improved Satisfaction Immediately After Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Double-Blinded, Randomized trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alaia et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomized double-blind, placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The experimental group received an oral tablet containing 25 mg of CBD 3 times a day if < 80 kg, or 50 mg of CBD 3 times a day if > 80 kg for 14 days after surgery, while the control group received an identical placebo dose. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">On day 1, the VAS pain score was significantly lower in the CBD group than in the control group, although this difference was no longer observed on day 2. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Effect of Cannabidiol Oil on Post-ureteroscopy Pain for Urinary Calculi: A Randomized, Double-blind, Placebo-controlled trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Narang et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomized double-blind, placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of cannabidiol oil for pain after ureteroscopy (20 mg cannabidiol oil vs placebo) daily for 3 days postoperatively \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There were no differences in postoperative pain scores or opioid use between groups \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delta(9)-tetrahydrocannabinol and the opioid receptor agonist piritramide do not act synergistically in postoperative pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seeling et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomised, placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">From the night before surgery until the morning of the second postoperative day, all patients received 8 oral doses of placebo or 5 mg of Delta(9)-tetrahydrocannabinol (dronabinol). Rescue with piritramide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No significant differences were found in pain reduction between the groups that received delta-9-tetrahydrocannabinol, + piritramide vs placebo + piritramide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A randomized, controlled study to investigate the analgesic efficacy of single doses of the cannabinoid receptor-2 agonist GW842166, ibuprofen or placebo in patients with acute pain following third molar tooth extraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ostenfeld et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomized double-blind, placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">single doses of GW842166 (100 or 800 mg) or ibuprofen with placebo in patients undergoing extraction of at least 1 fully or partially impacted third molar. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">123 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compared to ibuprofen, single doses of GW842166 (100 and 800 mg) failed to demonstrate clinically meaningful analgesia in the setting of acute dental pain. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lack of analgesic efficacy of oral delta-9-tetrahydrocannabinol in postoperative pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buggy et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Randomized double-blind, placebo-controlled clinical trial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of delta-9-tetrahydrocannabinol vs placebo (single identical capsule of 5 mg delta-9-THC orally) for postoperative pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No significant differences were found in pain reduction between the groups that received delta-9-tetrahydrocannabinol and placebo. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3675506.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical trials.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actitud y conocimiento actual del especialista en tratamiento del dolor español respecto al cannabis medicinal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. de Santiago Moraga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.20986/resed.2022.4032/2022" "Revista" => array:5 [ "tituloSerie" => "Rev la Soc Española del Dolor" "fecha" => "2022" "volumen" => "29" "paginaInicial" => "52" "paginaFinal" => "57" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cannabis-based medicines and the perioperative physician" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. 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