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Operative Obstetrics

Poster Session 2

(559) Associations between Endocannabinoids and Preoperative Pain in Patients Undergoing Cesarean Delivery: an Exploratory Study

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Endocannabinoids (EC) are endogenous cannabinoid receptor agonists involved in multiple physiological processes including nociception, cognitive function, and mood. We explored the hypothesis that EC levels in cerebral spinal fluid (CSF) and plasma are associated with patients’ preoperative pain and psychosocial phenotype prior to cesarean delivery.

Study Design:

Between 2021-2022, we enrolled pregnant patients without opioid use disorder or chronic pain and collected plasma and CSF during neuraxial anesthesia placement immediately prior to scheduled cesarean delivery. Preoperative patient phenotype was determined using pain and psychosocial measures including the McGill Pain Questionnaire 2 (MPQ-2) and PROMIS-29 profile. EC levels in CSF (2-AG) and plasma (2-AG and AEA) were assayed using liquid chromatography-mass spectrometry. Hierarchical linear regressions examined associations between preoperative EC levels and preoperative phenotype measures, controlling for confounding effects of age, body mass index (BMI) at delivery, and race.

Results: Complete data were available for 136 patients – mean maternal age 31.1 years (SD 5.3), BMI 34.4 kg/m2 (SD 8.6), 27.1% publicly insured, and 77.6% non-Hispanic White. Cannabis and tobacco use were uncommon (5.9% and 2.2%, respectively). Additionally, 22.0% had a current or history of psychiatric illness (e.g., depression), with half requiring pharmacotherapy (10.6%). Mean preoperative EC levels (in pmols/mL) were: CSF 2-AG: 2.1 (SD 1.1), plasma 2-AG: 52.4 (SD 28.3), and plasma AEA: 0.9 (SD 0.5). Elevated preoperative plasma 2-AG levels were significantly associated only with lower ability to engage in social roles prior to cesarean delivery; other ECs (CSF 2-AG and plasma AEA) were not associated with any pain or psychosocial measures (Table).

Conclusion: EC levels in CSF and plasma are unlikely to influence cesarean patients’ preoperative pain and psychosocial phenotype. Significant associations found in this exploratory study were limited to measures reflecting patients’ inability to engage in social roles.