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PostPosted: Mon Nov 11, 2013 5:06 pm 
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I am having surgery in 4 days and have been on Suboxine for 5 years. I am wondering if they will be able to put me under for surgery?


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PostPosted: Mon Nov 11, 2013 9:02 pm 
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Hi Rhonda, I personally don't have any experience with surgery on suboxone nor do I know much about it, but we have some members that do. I'm sure you'll get a few replies shortly. In the meantime, read some threads in the surgery section. You could easily stumble on some of the answers to your questions in already established threads.

Welcome to the forum!


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PostPosted: Wed Nov 13, 2013 2:04 am 
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Yes--- go to www.suboxsearch.com and search my blog, and this forum, for 'surgery'--- I have a post or two where I provide a standard letter that can be given to surgeons, and you will find TONS of comments from the forum. Basically, your docs need to ignore the number of mg, and focus on your respiratory rate (I used to be an anesthesiologist--- watching respiratory rate is the way docs and nurses measure the degree of narcotization--i.e. opioid effect). I have a couple downloads that will serve you well; the first is from NIH, about buprenorphine patients having surgery. My complaint about their recommendations, though, are that they stupidly (to quote someone else) say patients can simply stop their Suboxone a couple weeks before surgery. That comment shows a GREAT understanding of addiction, don't you think?!

http://suboxonetalkzone.com/bupe.postop.pain.pdf

The one below is something I give to my own patients when they have surgery. Believe me, I've heard some very horrible anecdotes-- surgeons who do surgery and say 'I'm not going to give you anything except tylenol', or surgeons who think that buprenorphine provides adequate surgical pain relief (it doesn't-- you are TOLERANT to those effects). I hope your surgeon is better than average in this regard-- good luck.

http://www.suboxonetalkzone.com/surgery.pdf


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PostPosted: Wed Nov 13, 2013 2:34 am 
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Thank you very much for the advice. You have no idea how releaved I feel about having the surgery. I have had such bad anxiety about the whole experience that it consumes my whole mind. I am worried about them being able to put me under being on the suboxine more then the actual pain management. I had a experience with a colonostomy that sticks in my head and scares me to death. I wasn't put under enough and I felt the whole procedure. That was painful and when I told them it hurt or was yelling they just kept saying we're almost done. I don't want that this time. I am up front with my dr doing the surgery but I don't feel she knew that much about it. I plan on being honest with the anestheologist. I just hope he knows what suboxine is about. I don't want to be pushed aside and go through this in pain. It scares the hell out of me.


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PostPosted: Wed Nov 13, 2013 12:14 pm 
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So by me reading your info it makes me wonder are you saying that I can't be put under because I am on such a high dose of suboxine? I am on 24 mg. a day. I understand that it is not going to work as a pain med after surgery but I am more concerned about going under. I have a plan to use Tordol after the surgery. I am just freaking out about being put under.


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PostPosted: Thu Nov 14, 2013 12:44 am 
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There is no dose of buprenorphine that cannot be overcome by a sufficient dose of opioid agonist-- but it would take a lower dose of agonist to overcome a lower dose of buprenorphine. I tell people to reduce their dose to as close to 4 mg as possible; realize that 8 mg per day, taken efficiently, is plenty of buprenorphine to prevent 'real' withdrawal (you might have a few sweats, but nothing dramatic---- people who taper usually discover that they were on a lot more buprenorphine than they realized!). If your doc just focuses on YOU, and uses a narcotic that can be given in high doses, your treatment will not be difficult. Any good anesthesiologist should know to avoid using morphine in a case like yours, because morphine lowers blood pressure by causing histamine release, and very large IV doses will make you break out with itchy spots.... Demerol is not appropriate either because high doses have toxic breakdown products that can cause seizures. But this is all basic info to someone who works in the OR. PCA fentanyl works very well (where the patient gets a constant infusion, but can give booster shots as well)-- as long as the infusion is set high enough. There are ways to check the history of the machine and see how many tries you made for more relief, and then the base rate is increased.... the tools are all there to manage the problem-- you just need a doctor smart enough to use knowledge from med school, who will stand up to the nursing supervisor who is 'uncomfortable' with such large doses. If the surgery is major, consider telling them you want to use the ICU if your pain isn't controlled well; they can give larger doses of pain meds in the ICU in many hospitals.


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PostPosted: Thu Nov 14, 2013 12:49 am 
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The colonoscopy situation is common in people on benzos. They often use a benzo called midazolam or versed to cause the amnesia part of the sedation, and I've had patients who were taking 10 mg of Xanax per day who didn't respond to any dose of versed because of tolerance. but during surgery, amnesia is usually caused by either vaporized agents (desflurane, isoflurane, sevoflurane) or by infusions of diprivan, the Michael Jackson drug (that is very safe when used with appropriate monitoring and equipment).

People having MINOR procedures---- dental work, D and C, scopes above or below, hernia repairs, carpal tunnel, skin procedures, etc--- MUST tell the surgeon if they are taking a significant amount of a benzo. Not telling that information places you at very high risk for recall during the procedure.


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PostPosted: Thu Nov 14, 2013 12:05 pm 
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I am having the NOVASURE E ABLATION. It is suppose to be a short and sweet procedure. I am on 1 and a half mg of Klonopin a day for anxiety. I have been really scared more of the sedation then the pain management. They tell me the pain shouldn't be more then Tordol can handle. I will for sure tell all drs of what I am on. I want no repeat of the colonostopy. Thank you very much for answering my post and making me feel more at ease about the procedure. I was told and watched video's on the procedure and it seems quick so hopefully they don't have a problem. I am not sure what to expect for pain right after the surgery but I feel better about it hearing from you that they should be able to control it. Well the surgery is tomorrow so we will see how it goes. Thank you again for the info.


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PostPosted: Sun Nov 17, 2013 1:37 pm 
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So surgery went well and I am doing good. I was very lucky my recovery nurse was very educated on Suboxine. So everything went much better then I was expecting.


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PostPosted: Sun Nov 17, 2013 9:03 pm 
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That's good to hear, Rhonda! I'm glad everything went well! :)

Amy

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