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PostPosted: Tue Feb 01, 2011 5:54 pm 
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Hi Everyone:

I'm new here and need your help. I am in recovery, coming up on my year cake on Feb 8. :) I am currently on 8mg of Suboxone per day and have been for the entire year.

I am scheduled to have a colonoscopy next week (Friday). The doc doing the procedure knows I am on Suboxone and in recovery though he doesn't know very much about Suboxone. He said he will use Versed and Fentanyl to sedate me for the procedure. My addictions doctor, whom is wonderful, agreed that this will work and that I should NOT stop taking my daily 8mg of Suboxone prior to the colonoscopy. He stated that Fentanyl is one of the only analgesics that will actually work while I am on Suboxone due to the fact that on 8mg I am only partially blocked.

My questions: has anyone heard of Fentanyl working while on Suboxone? Will the anesthesiologist need to give me a higher dose of Fentanyl? Are there adverse side effects?

Thank you so much for your help!


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PostPosted: Tue Feb 01, 2011 7:12 pm 
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Hi,
Congrats on your year!
I was a CRNA (nurse anesthetist) prior to my 2nd relapse on opiates....It really sounds like your docs have a good plan. I don't know for a fact that fentanyl will work this way on Sub but it makes sense and I have heard this before that Fent will work. I wonder why they don't just use propofol? You really don't need anything for pain and they could also give you a little versed for the amnesic effects. I would probably use propofol on a patient if it were me. I've' done these procedures before but not with any pt on sub...and I usually only use Propofol, with preop versed/fent. there is virtually no pain after unless you have something else going on that I don't know about (I've also had a colonoscopy myself but not while I was on sub and they used versed/propofol).
It really sounds like your docs have it under control. And I hope all goes well for you.

Again, congrats on the year. Good job. Maybe you can share how the year went for you, what kind of recovery plan you work if you do have one? We have been discussing this a bit lately.


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PostPosted: Tue Feb 01, 2011 10:40 pm 
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I pretty much agree with Chinagirl, and she certainly "out ranks me" being an advanced practice RN while I'm a Paramedic. But I'll throw in a few more items. The important drug here that you'll be getting is the Versed. It will do more for you during this procedure and most importantly, won't at all be affected by the Suboxone. As China said, it also (if given correctly and in high enough dose) should erase everything from your memory. Many people report not remembering the procedure at all. It really does work that well.

Now, the Fentanyl... I too have been told by my Sub doc (who is also an anesthesiologist) that Fentanyl is able to break through the Suboxone. The thing is, I have not heard from anyone who can report that it has worked. What I have heard is at least from a few people that it does not work. One is here on the boards and had to have a biopsy procedure aborted due to the Sub blocking the Fentanyl. Certainly you will need more than average. If I had to guess, I'd put a few dollars down that they typically use 25 micrograms to 50 micrograms of Fentanyl for a procedure like this. As China said, and I do as well above, the important drug here is the Versed. They add Fentanyl to the cocktail because in combination, it will help with your sedation. It is pretty commonly done for a wide variety of procedures. My (now ex) wife ran a cardiac cath lab, and I did a bit of work in there as a tech and I can tell you just about every doc started with 2 mg of Versed and 50 mg of Fentanyl to do caths. Again, just like as addicts many here added benzos to the opiates for a better "high", adding a little Fentanyl to the Versed (which is a benzo) helps to sedate and relax you. It's a pretty common drug cocktail for sedation.

So the thing is, even if the Fentanyl doesn't do much, it won't be that big of a deal. That said, it also would not at all hurt for them do double or even tripped the Fentanyl dose due to the Sub. They very likely would not do this to start with. They would do the normal dose, but they could then give you more if needed. I don't know how to suggest you tell them this, but if you can drop the hint that you have been told that it is common to double the dose for Sub patients, that might help. The best really, would be just tell them how you are feeling when they start. If you are relaxed and do fine it won't matter. Again, in the end of the Versed does it's job, you won't remember any of it. And I really do mean - any of it! It's like it never even happened.

If you are really worried and you don't think they will agree to higher than normal doses of Fentanyl, you could skip taking your Sub for at least 24 hours. If you take it in the AM, don't take it on the day of the procedure until you are done. If you take it in the PM, skip the night before the procedure. Due to how long Sub lasts in the body, it is very unlikely for you do feel any withdrawals. While you'll still have Sub in your body, the level will be a bit lower if you can stop 24 to 48 hours prior. I'm not saying you have to do this. I'm just suggesting it if you are worried.

And China, since I was willing to bet on the Fentanyl dose, I'd also throw down a few Monopoly bucks on a bet that they are not using anesthesia docs or nurses for this procedure and that's why they can't use Propothol. Most facilities restrict that drug to anesthesia practitioners. It is likely that the doc will have RNs doing the "conscious sedation" and they are not allowed to administer Propothol. Many times they require additional monitoring such as end tidal, etc. I agree with you that "Milk of Amnesia" would work better, but it's just not worth the extra risk so they don't allow it. (The nickname comes because the drug is white and looks like milk in the syringe) This is the drug that reportedly killed Michael Jackson.

Good luck and if you would, stop back after the procedure and let us know what happens and how you did.


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PostPosted: Wed Feb 02, 2011 3:01 pm 
Hello NYC....Congratulations on making almost one year in recovery! That is awesome! Sorry you're having to have this procedure done, but it is an important, potentially life-saving thing that we all will need to have done at one time or another.
I just thought I would throw in my opinion along with the other excellent responses you've already received. I too am a former health-care professional (RN) and I agree with what the others have said. I just wanted to chime in about the Fentanyl issue. I don't know where the theory that it, unlike every other opioid agonist out there, will 'break through' buprenorphine comes from. I suppose there is some study or something about it's chemical makeup or something that is way over my head that brings about this theory, as I've heard of it before. However, I have never heard of an actual personal experience with it that says that it's true. In fact, I've heard several that would say it is absolutely NOT true. That leads me to believe that there isn't really anything special about Fentanyl when it comes to it's use in the presence of Suboxone. Fentanyl is a very effective drug, no doubt, but I would bet that it would take double, if not triple the 'accepted reasonable' dose to trump the buprenorphine, as donh suggested.
I'm also curious as to why your doctor would tell you that you're only partially saturated with 8mg/day of Suboxone for nearly a year. To my knowledge, it's pretty well accepted that anything over about 4mg/day provides complete opiate receptor saturation. At your dosage, it would take quite a hefty dose of any opiate agonist to overcome the blockade effect of your Suboxone.
I also agree that Propofol (Diprivan) would be a nice alternative. But again, I agree with donh, not likely to be given without more than the usual monitoring and presence of anesthesia personnel, which is not generally the standard with colonoscopy.
Again, in agreement with the others, I think the Versed is what will get you through more than anything else, as it is not an opiate, therefore the Suboxone won't interfere with its action.
While I would not suggest you go against direct doctor's orders, I don't see how it could hurt to skip a dose or two of Suboxone prior to the procedure. Doing so might allow the Fentanyl to work a little bit at least....maybe.
This is one of only a few (in my opinion) true and real and undisputable downsides to being on buprenorphine.....when the need for analgesia arises, it leaves us in a pickle. All we can do is do our research and learn from the experiences of others as to how to deal with these issues. Fortunately, most of the time, with procedures such as the one you're having, everything goes pretty smoothly. Please come back and let us know!


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PostPosted: Wed Feb 02, 2011 4:37 pm 
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I am not a medical professional, so I can't add too much to what's been said here. However, about 8 weeks ago I had an upper GI endoscopy. They used propofol, but after the procedure, they told me they also had to give me Fentanyl. They never said why, but the only reason that made sense was for them to sedate me a little bit more. Maybe they didn't want to give me any more propofol? Who knows. Not that any of this helps you, but I thought I'd share my experience.


I also wanted to touch on the opiate receptors being saturated at or around 4 mg. This is generally accepted to be very true. But it's my understanding - and according to Dr. Junig - that it takes a higher dose than that to KEEP the opiate receptors saturated all the time. This would account, I think, for the difference in doses people use (that and the dose it takes to address individual cravings). That said, 8 mg is double the ceiling and one would think that it would be plenty to keep those receptors saturated. Maybe he can explain why he's thinking that. Interesting.

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PostPosted: Wed Feb 02, 2011 6:15 pm 
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According to my doc (and I think I looked it up after he told me to see if it were true). The receptors ate 94% saturated at 16 mg per day. This is not to be confused with the ceiling level, which means that your blood level has reached a steady state, i.e. you don't have fluctuations up and down as you dose.


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 Post subject: check back in
PostPosted: Wed Feb 02, 2011 9:06 pm 
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Let us know how the procedure goes for you....if you can find out what they gave you and the doses. They will tell you if you ask.

What Donh said is true....fentanyl and versed together are potentiated....a better cocktail. You might need more versed than normal, too, just because of cross tolerance. Who knows. As long as they are aware that they will need to adjust their usual practice it'll be fine. I always just followed what my patient needed....just like here, some need more, some less.

Propofol is given by regular RN's in my state...but i don't know who will be doing your procedure. Just my last 2 cents I'd rather have propofol gtt and be kept "out"...a little versed for amnesia and viola! you're done. LOL

It will be slick...no doubt.


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PostPosted: Sat Mar 12, 2011 8:55 am 
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I can only add my personal experience with Versed and Fentanyl while taking 6mg of suboxone and I'm sorry to tell you that it did not work for me -AT ALL. Last year I needed a liver biopsy (I'm HepC positive and require biopsy every 2 years). Typically, the way they collect the sample is to put you in "la la land" with the Fentanyl/Versed mixture (some docs use Demerol/Versed) and then they insert a large needle between your ribs to collect the sample. Unfortunately for me, even after having told the intern who was doing my procedure that I was on suboxone and would require extra drugs to offset the blocking effects of suboxone, and despite the fact that I completely stopped taking my suboxone 72 hours prior to the procedure, they had no choice but to abort the procedure because I was 100% completely wide awake and felt everything as if they had given me nothing.

I ended up having to go completely under (with Propofol and an Anesthesiologist helping me breath through a tube) in order to have the procedure done.


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PostPosted: Mon May 09, 2011 6:16 pm 
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NYC I hope you are well. I know this answer is too late for you but might help someone else. They tried to do a colonoscopy on me, but fentanyl and versed did not work at all. I ended up having a barium enema instead, not pleasant but a thousand times better than trying to do the colonoscopy when the sedation failed. I was on 8 mg of sub at the time.


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PostPosted: Mon May 09, 2011 8:52 pm 
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I had a colonoscopy 3 wks ago and discussed with the doctor about my sub use. My normal dose is 6mg a day. I did not take my morning dose on the day of the procedure.

They decided to do 100 mg of Fentynal and 6.5 mg of Versaid........did not work at all. I felt the entire procedure and it was very painful for me. They ended up sending two nurses in to hold me down while they completed it.

In the end all the Dr said was your tolerance was too high and it was clear he was not going to push it. I had to just tough it out. Some say it doesn't hurt and what is the big deal but the bottom line is it did hurt and nothing they gave me helped. This is what scares me the most being on suboxone as I need at least two more surgeries- prostrate and elbow and I am scared to death I will not get pain relief.

Please come back and let us know how you made out.

Jim


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PostPosted: Sun Aug 07, 2011 1:30 am 
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I have had 4 C-sections and with all 4 I received Fentynal in the recovery room. It was one of the only things that helped. It didnt help like it would help a regular person. But it did take the edge off. I also didnt take a dose for 24 before the sugrery. They also had me on a Morphine drip...the PCA pump for 24 after I left the recovery room. It didn't do SHIT. I was on 1mg every ten mins with a 5mg bolus (sp?) every hour. At one point I just told them to take it off....went straight to norco after that for another 24 hours....didn't work. Then I just went back to Suboxone which surprisingly helped more!

PS: I also received Demoral while leaving the OR. I was used to control the insane shaking that was happening to my body. I couldn't help it! it was almost like I was having a seizure! The Demoral helped for that but we didnt use it for actual pain control.


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PostPosted: Sun Aug 07, 2011 1:48 am 
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:wink: Ok... I just had to chuckle a bit seeing all the health care people here which I suspected due to the clinical accuracy of the terminology used. Soo.. thought I'd chime in and let ya know I'm a retired RN. I haven't practiced in over 8 years, after I got injured I retired. Great diversity of resources here for sure.
Anita

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PostPosted: Tue May 28, 2013 11:16 am 
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I am supposed to have both a endoscopy and colonoscopy. I have been taking only 2mg subutex for some time now. Is that a low enough dose to not effect the cocktail they will give for the procedures? Should I still stop taking my dose beforehand. The 2 mgs holds me about 24 hours and then I start to feel all achey


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PostPosted: Fri Jun 14, 2013 12:21 am 
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tinker wrote:
I am supposed to have both a endoscopy and colonoscopy. I have been taking only 2mg subutex for some time now. Is that a low enough dose to not effect the cocktail they will give for the procedures? Should I still stop taking my dose beforehand. The 2 mgs holds me about 24 hours and then I start to feel all achey


I have been taking 8mg (1 tablet) of suboxone for several years and came upon this subject. I thought I'd relay my experience. First, I've had no major operations, but if I'm going to have a painful procedure I always tell the treating Dr. that I am taking suboxone and if they're not sure of how it relates to pain, etc. I ask them to please call my Dr.

A few years ago I needed to have an "endoscopy" for a hiatal hernia. They gave me Versed and (I forget the name of the other med, but it's standard). They & I also decided that I would have a colonoscopy as well since I had been meaning to do that. The endoscopy was just uncomfortable, but not painful. However, the colonoscopy had to be stopped because it was excruciatingly painful. I didn't expect that much pain.

So, I've always wondered if they gave me enough or it was just too painful for me while I was awake and groggy. I have not tried to get another colonoscopy as I fear that pain! How does one get put out completely and not feel pain?


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 Post subject: Pain in the butt
PostPosted: Fri Jun 14, 2013 1:55 pm 
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This is a good subject to be brought up again. Lucky for me, my first colonoscopy was done before I was on Sub, but then you're supposed to have one every 10 years after the first one. That won't be for another 5 years at least.

Way at the beginning of this thread a RN said Propofol should be used. I will agree with that statement. Mix it with Versed and the procedure should be a non issue. The problem lies with the doctor. He/she must be informed of your Sub use way beforehand so they know how and what to administer. I will not bother to have my second one if they can't knock me out properly. My first time I was given Demerol & Versed, which wouldn't work now.

Give me my Jackson Juice and all will be fine.

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Last edited by rule62 on Sat Jun 29, 2013 2:45 pm, edited 1 time in total.

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 Post subject: Re: Pain in the butt
PostPosted: Fri Jun 14, 2013 3:26 pm 
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rule62 wrote:
My first time I was given Demerol & Versed, which wouldn't work now.

Give me my Jackson Juice and all will be fine.


Hi,
Now I remember....I too was given Demerol and Versed. It definitely relaxed me and made me sleepy but it did not help at all with the colonoscopy. That was SO painful that I started to cry & they had to stop. And I DID tell the person that I was on suboxone. Why don't they know better?

So...what should I ask for next time? Propofol & Versed?

Thanks so much.
Trudi


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PostPosted: Sat Jun 29, 2013 5:38 am 
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I had a colonoscopy 2 weeks ago while on 8mg. /day.
Here's what I did to make it successful.
I was not to have an anesthestheologist...just stuff to make me GROGGY.
I did a fast taper to 4mg. then took none the morning of the colonoscopy.
I told EVERYONE about my sub. use, prior, however it did not come up until I was in a
hospital smock, freezing, with a needle in my arm.!!!!

Because I told everyone what I had read here., and
Because they were not going to knock me out completely...
The doc. doing the colonoscopy said :
"I think we'll need to call in an anesthesiologist. to administer Propofal which 'will knock anyone out'...
This will take 3-4 hours before one (anesthologist)can break away and get to this floor."

I said to the doc. "I'm freezing here, let's do this. If I feel pain we can stop"
So they wheeled me in.
Here is what they gave me:
Benadryl .50mg IV
Fentanyl .200 mcg. IV
Versed 8 ml IV during the procedure

It went perfect. I was awake the whole time and felt nothing.


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 Post subject: Suboxone & Fentanyl
PostPosted: Sat Jun 29, 2013 5:31 pm 
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Hello,

I tried to have a colonoscopy a few years ago. They gave me fentanyl and versed and I also told the Dr. and prescribing Dr. about it. Both said it should be OK.

However, it was so painful for me that they had to stop in less than a minute. Just couldn't go on. I'm no sure if this is related to the medications I was given or the procedure itself. Some people can tolerate colonoscopies more than others. A friend of mine did not feel any pain at all.

I guess you'll find out.


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PostPosted: Thu Sep 19, 2013 9:21 pm 
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Fentanyl will not work!
If you know you will have surgery stop suboxone for at least 4 days and then you can be put under very easy.

I had throat surgery and Dr said stop sub for at least 4 days and I was out after 1 shot of fent.

I had a colonoscopy,that dr oh continue taking sub not knowing what is was,I felt everything nurses held me down as he blew air in my colon and I filed a complaint against Dr,he did not know anything about Sub.We didn't choose to become addicted to pain meds,but it's our responsiblity for our recovery.

Should we wear a red-cross symbol saying we take Sub or will that result in no pain management at all???I would not like to wake up if in an auto accident or emergency injury,because of Sub blocking what they use to put you under.

We didn't choose to become addicted to pain meds,but it's our responsiblity for our recovery.


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PostPosted: Sat Feb 08, 2014 2:13 pm 
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I have been on sub for 3 years or so. I got down to 4 mg a day but then doc decided to keep me on sub for pain control. Long story short I can't take NSAIDs due to recurring ulcers due to chronic neck pain.

I was severely anemic so yesterday I had colonoscopy and endoscopy. I stopped the sub 48 hours in dnvace and cut back to 4 mg a day for a week leading up to that. The verced fentanyl cocktail made me drowsy but I felt and remember every minute. Doc said they gave me all they could. The coplonoscopy hurt like hell.

I have a second neck surgery scheduled in 10 days and while I'll be under general anesthetic for the procedure I am scared top death about dealing with pain afterwards. Last June I had emergency I surgery on my hand. The first 24 hours I was in terrible paid. IV morphine did nothing. I wasn't able to prepare for that procedure at all, but I'm wondering on what I can do or ask for. After hand surgery, while still in recovery the nurse gave me a shot of Demerol, which helped, but once out of recovery they wouldn't give me Demerol. They kept me on IV morphinje for 2 or 3 days but it never did help. I started my sub back up about the time the pain lesson end anyway when I left the hospital.

I have this same neck fusion once before when I wasnt on sub and the Percocet managed the pain fine so I'm not sure how much pain to expect if nothing works. Am I going to have to go into withdrawals from sub before the surgery?


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