It is currently Wed Aug 16, 2017 9:35 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 6 posts ] 
Author Message
PostPosted: Tue Dec 08, 2015 8:06 pm 
Offline
Average Poster
Average Poster

Joined: Tue Sep 09, 2014 5:42 pm
Posts: 15
I'm telling my story from May 2015. I have been on 8-16mg/day of bupe (no naloxone) for Cluster Headaches, aka "The suicide disease" since December 2014. I was referred to Stanford for a procedure where they place a stainless steel probe into my head and I have to be awake so I can tell them which nerve they are touching. The probe is like a long, thick needle that is hollow. It entered my head just below my earlobe and passed through my jaw muscle. They were targeting a nerve cluster at the back of my nasal cavity, just outside my cranium.

In pre-op I explained in detail to the anesthesiologist that I have been taking bupe and showed some articles on how to overload the patient with fentanyl to overcome the bupe. He studied the article and showed it to the neurologist who was performing the procedure. They agreed they could "go over" the bupe and would try to make this as comfortable as possible because it's a notoriously painful procedure and requires the patient to be awake. They also said it would be only about five minutes once they introduced the probe until it was over. I made a point to remember the anesthesiologist's first and last name going in.

Once inside the operating room they firmly strapped my down to the table "for my own good". That told me it's going to be tough for the normal person who would likely try to get up and run away. Then they strapped my head down and put a fluoroscopy machine around me. That's for real-time x-rays. I could see my skull on a large screen monitor to my right, in real time as I opened my jaw.

Then they started the IV and gave me ativan and fentanyl. After a little while I felt warm and relaxed. Then the probe went in I started gurgling and groaning and said "uggg Caroline I can't do this". She and the neuro looked at each other the neuro said 20 something something. That helped a little, then the neuro moved the probe again. I arched my back as much as I could and wailed. Then they said 40 something something. Then I was ok, except for massive pain on the left side of my face. The neuro said "ok, the probe is in place we just need to find the right nerve". This is probe time plus five minutes. The neuro wiggled the probe around and turned on various nerves that caused this bizarre feeling in different places in my face. In many cases it was like I was getting my lip pierced. The probe was in for a total of 90 minutes. Most of the time I was begging Caroline, but on a few occasions I was awake but totally out of it, no pain, no anxiety. Back in the recovery room the meds wore off quickly and it felt like I'd been punched on the face. The neuro gave up and said he never found the nerve. The anesthesiologist said she gave me enough fentanyl to kill an elephant.

Had I not explained the bupe issue beforehand and had the team not been comfortable with "going over" the bupe it would have been absolute torture. The typical patient describes it as "pretty painful" and I'd say I had my share and more of that. But it could have been way way worse.

Makes me think I should have an ID band in case I need emergency surgery, and also that all anesthesiologists need training on "going over" bupe.

My advice is to meet with your anesthesiologist and surgeon beforehand to be sure they realize they need to massively increase the fentanyl, and that is safe for somebody on Bupe.


Top
 Profile  
 
PostPosted: Wed Dec 09, 2015 12:41 am 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2801
Location: Southwest
Very well said and I agree that all surgical physicians should be up to date on Buprenorphine and the difficulty of pain relief for those on it.

What dose where you on at the time? Meaning, I wonder if less narcotics could have been used if the patients dose of Suboxone is under 4 mg's. Just curious, that's all. But I too have had surgery and suffered because none of them understood how Bupe worked.

Thanks for sharing your story,

rule

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
PostPosted: Wed Dec 09, 2015 8:07 am 
Offline
Moderator
Moderator
User avatar

Joined: Tue Mar 11, 2014 10:48 pm
Posts: 1313
What I get from the op is that it is extremely important to talk to your drs before any surgery. Plus, it says that the op was on 8 to 16 mgs of bupe for the last 6 months before this surgery.

To me it reinforce s the need and believe that as soon as possible we need to drop or get our doses down as close to the ceiling (4mgs) as soon as we can.

At least to the single mg range be it 9,8,7 to 4mgs... thanks for shairing your story Trig, hope your feeling better...

Just my 2 cents..

Razor...


Top
 Profile  
 
Our Sponsors
PostPosted: Wed Dec 09, 2015 8:07 am 
Offline
Moderator
Moderator
User avatar

Joined: Tue Mar 11, 2014 10:48 pm
Posts: 1313
What I get from the op is that it is extremely important to talk to your drs before any surgery. Plus, it says that the op was on 8 to 16 mgs of bupe for the last 6 months before this surgery.

To me it reinforce s the need and believe that as soon as possible we need to drop or get our doses down as close to the ceiling (4mgs) as soon as we can.

At least to the single mg range be it 9,8,7 to 4mgs... thanks for shairing your story Trig, hope your feeling better...

Just my 2 cents..

Razor...


Top
 Profile  
 
PostPosted: Thu Dec 10, 2015 12:53 am 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1542
Understand that you had something called 'conscious sedation'. With that technique, patients are supposed to be awake enough to maintain an airway-- so patients are SUPPOSED to be allowed to 'surface' from time to time, and talk with the surgeon.

During conscious sedation (also called 'MAC'), the benzo is used to block recall, and the opioid (fentanyl) is used for pain. Understand that in opioid-based anesthetics-- such as cardiac anesthesia-- recall is fairly common. The main drugs that cause recall are benzos or benzo-related meds, like alcohol or barbiturates. I don't know if you took benzos, but that is a much greater risk factor for recall than opioids like buprenorphine.

During general anesthesia, people usually receive meds that are not related to opioids, making recall a non-issue. Typical general anesthetics are the inhaled agents like isoflurane or sevoflurane, or propofol. Use of opioids does NOT increase the incidence of recall on these medications. Neither does the use of benzos. But under general, patients are usually intubated, and often paralyzed.

Bottom line-- risk of recall is a much greater issue in benzo-users than in people on opioids like buprenorphine. But if you are having a general anesthetic, recall would be highly unusual. The exception would be the cases where doctors have to avoid giving anesthesia-- for example during c-sections, before the baby is delivered, or during trauma when a large amount of blood has been lost, and not yet replaced.


Top
 Profile  
 
PostPosted: Sat Apr 16, 2016 4:57 am 
Offline
Power Poster
Power Poster

Joined: Mon Jun 08, 2015 10:39 am
Posts: 54
OMG you poor thing! What a terrible procedure and I am so happy you had a smart anesthesiologist who listened. I had a similar procedure done to my lower back once where they also used a fluoroscopy? (sp? the real-time xray thingy lol) and my pain was 10+++ so bad i was crying AND laughing at the same time. This has nothing to do with suboxone though as I was not on subs at the time. This was back in my opiate-abusing days when I had legit lower back pain and they were trying to figure it all out.

I know this post was way back, but I am wondering what is "recall"? Is it the ability for a patient to "recall" his operation? Like inside his memory? And what is the hard in remembering it anyways? I can still remember the pain from my procedure and it makes no difference (I think) to me if I had or hadn't rememembered it since once the pain is done it's done.


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 6 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 1 guest


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

 
Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group