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PostPosted: Sat Jan 12, 2013 4:06 am 
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I'm having a c-section next week and the doctor cannot figure out how to treat my pain because he has never dealt with suboxone before. I am allergic to morphine so I know he is using fentynal thru the epidural. Does anyone suggest an epidural over a spinal epidural? Just asking cause he isn't sure which one to do. I'm currently on 20Mg (2.5 8Mg films) per day. He is going to use dilaudid for the treatment of pain post operative but isn't sure on that dosage either. I'm afraid my pain issues aren't going to be addressed. I have chronic pain issues that need to be treated as well. Any insight would be helpful!


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PostPosted: Sat Jan 12, 2013 1:14 pm 
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http://www.suboxonetalkzone.com/surgery.pdf

this is a write up on HOW/what hurdles need to be addressed to treat pain in suboxone patients, surgery with suboxone patients....

I don't know about a conversion table, but I'd definitely print out the above "summary" and take it with me.


well I hope that helps!! and good luck with everything, congratulations!!!!

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PostPosted: Mon Jan 14, 2013 6:43 pm 
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Markey, I hope you're checking for replies. The link Amber provided is a good one.
I have a pretty extensive background regarding the things you're asking. Thankfully, I had my babies long before I became addicted to opiates, so I have no personal experience. However, I do have experience in this area of medicine.
I would probably recommend that you request a spinal block rather than an epidural. The spinal block generally provides a denser or heavier block...ie you'll be completely numb from about the waist down. Whereas an epidural is not quite as 'strong'...you'll usually feel some pulling/tugging type discomfort and often can still move your legs around a bit. Most doctors will use a medication in both the epidural and the spinal which lasts several hours and gradually wears off...so both are good in that regard. The other option to ask about is this: IF they'll give you an epidural for the C/section AND leave the epidural catheter in place in your back AND let you have a continuous medication infused through it for 12-24 hours after surgery (like they do with labor epidurals) then that might be an even better option than the spinal block.
The thing is....you're going to be almost completely dependent on your anesthetic for pain control. You're on a high dose of Sub and your opiate receptors are pretty much completely saturated....any pain medication they give you on top of all that Sub is most likely not going to break through it and you'll get no pain relief. Make sure they give you Ibuprofen routinely and request Toradol...it works pretty well for post op pain.
The other thing I'd suggest is that if you have time....if your surgery is still at least 5-7 days away....I'd drop my Sub dose dramatically and immediately. You should have enough Sub stacked up in your system that you could literally drop to 2-4 milligrams a day and not have any withdrawal symptoms whatsoever. I'd also stop the Sub completely 2-3 days prior to surgery. This might give you at least some chance of having opioid pain meds such as fentanyl or dilaudid provide you with some relief should you need it.
Also keep in mind that the doctors can give you non-opiate meds during surgery or in the immediate post op period that can sedate you and give you some relief that way if necessary.
Also make sure that your doctors and nurses know to not give you a drug called Nubain or Narcan (which are sometimes ordered for anesthesia related itching or side effects.) Those drugs can cause horrible withdrawals to opiate dependent patients.
Sorry for the lengthiness of this post....it just really worried me for you when you posted that your doctor doesn't really know what he's dealing with regarding how to deal with your Sub use. As far as equivalencies go.....Sub is a different animal...you can't really calculate dose equivalencies like you can with other opiates. Suffice it to say that you're well above the accepted ceiling dose of buprenorphine. And that means that in order to get you a high enough dose to overcome the blocking effect of the bupe, most doctors and nurses would be afraid to give that much.
Now that you're probably on information overload...let me reassure you with some good news! There are many women who have C/sections and their spinal or epidural provides such excellent relief that they do just fine with just ibuprofen and Toradol. Also, some people find that their Sub dose provides at least some measure of pain relief all by itself.
I am not a doctor and all the information I provided here is just based on what I've seen, read and heard. It is accurate to the best of my knowledge, but certainly is not guaranteed to be 100% accurate. I'd recommend discussing all this with your obstetrician and anesthesiologist and others involved in your care. Also share it with your support person so he/she can advocate on your behalf should any issues arise.
Best of luck and congratulations on your baby!


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