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PostPosted: Fri Apr 08, 2011 12:27 pm 
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This is what my experience was....and stalk up on popsicles, yogurt, ginger ale/sprite, salt for salt water rinses....
Had upper molar abscess with maxillary sinus involvement. Spent two days in pretty excruciating pain waiting for extraction.

I didn't stop my sub. In fact i took an extra dose of 8mg sub at midnight prior to the surgery because of pain, plus a lot of ibuprofen.

I would also recommend an oral surgeon to do a tooth extraction for those of us who have complex medical/addiction histories...they are more comfortable with medications, and will do IV sedation if needed.

Morning of surgery: took my usual dose of Sub 6mg at 7am. Procedure was scheduled for 1145am.

I did not tell dr about my use of Sub but I did tell him that I am in recovery from addiction to opiates. Telling him about sub is a personal thing...I didn't only because I had had a situation with a regular dentist the day before trying to find someone to help me deal with the abscess and extraction. All i told my oral surgeon was that I take a medication that might make it difficult to sedate me and I may need more than usual people. he was fine with that.

I ended up having a total of 100mcg of fentanyl and 8.5mg versed and odansetron (for nausea) for the IV sedation during the extraction.He offered me nitrous but i declined as it makes me very nauseated. I remember very little and I would recommend this route. My only issue is the sedation was twice as expensive as the extraction. Ridiculous. I know how much fentanyl and versed cost...and putting in an IV is no big deal! Oh well...

He rx Lortab 7.5/500 for me post op. And used a longer acting local anesthetic (ask for this, it helps).
Within 30 min after the procedure I had pretty moderate to severe pain. My first dose was:
4 Lortab, 4 ibuprofen in the car on the way home
went home and slept a couple of hours
2-3 hours later: took another 2 Lortab and 2 ibuprofen
2-3 hours later: took another 3 Lortab and no ibuprofen (I had had too much ibuprofen the night before and my stomach was hurting)
That was it...The last lortab was at 6pm....slept at night, woke up a few times more due to nausea than pain.
Total: 9 lortab the first day only/6 ibuprofen

Next Day: 8am had moderate pain, took 2 ibuprofen, no lortab. did salt water rinses.
At noon dosed 4mg Sub (18 hours after last Lortab) I started to feel kinda weird just before I dosed my sub...not w/d exactly just strange. Felt kinda normal again after taking my sub.

That was it. Seemingly an extraction is no big deal but they hurt like hell so I'm glad it ended up the way it did...again, I'd suggest an oral surgeon not a dentist for anyone who needs extraction. Oral surgeons have 4 months of anesthesia rotation during their residency and are just more comfortable with our more complex medical histories, imo.


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PostPosted: Fri Apr 08, 2011 12:47 pm 
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Yay! You got through it! Phew, I'm so glad that's over with. The whole mixing regular opiates and Sub totally scares me. You're in a unique position with all the medical knowledge you have. Can we all start hitting you up for advice when we need to have unexpected procedures? :D Did you feel any w/d at all? And as far as the Lortab, did it seem to truly work? I"m wondering if the Fentanyl was effective in knocking all the Sub off or not. I hope you feel better soon now that the bad tooth is out. They really get you on the sedation, don't they? I had my teeth overhauled in July and that's when I upped my dose from 3 to 8 mg of Sub. I got the laughing gas, which was really pricey. All I have to say about that is 'BARF'!

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PostPosted: Fri Apr 08, 2011 6:05 pm 
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Thanks for sharing! Ideally, dentists can block the nerves to most upper or lower teeth, providing pain relief during the procedure (except for the pain of yanking your mouth wide open or twisting your head to the side!). For minor work, ice and large doses of ibuprofen (800 mg every 8 hours) will do the trick, but for major work, I recommend that people educate their addiction doc about the proper way to treat pain in people on buprenorphine-- i.e. use opioid agonists in high doses, on the order of 15 mg of oxycodone every 4 hours. Please provide them with this article if they seem clueless: www.suboxonetalkzone.com/bupe.pain.pdf


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PostPosted: Sat Apr 09, 2011 10:57 am 
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hey ladder....you asked about the effects of fentanyl and lortab post op....

I really doubt the fentanyl provided any kind of real pain relief...what it did was potentiate the effect of the versed more than anything...and whenever I did sedation cases i would always use that combo...its just a nicer sedation. and no, I do not think it over rided my sub...so i've basically said the opposite haven't I? LOL....ok, the real answer? Who the hell knows.....!

Postop again, I do not think the lortab did much more then the ibuprofen. I can tell you this, I did not feel the lortab...I didn't get a euphoria or any kind of high from it. i think more than anything it might have all been mental...and that the ibuprofen worked just fine by itself.

Today is 2 days post extraction and i still have achey pain that 600mg ibuprofen seems to cover. I take it 2 or 3 times a day right now, and do salt water rinses 3x/day. Tomorrow I will irrigate the extraction site with salt water and it should be all fine by then.
I slept fine last night and feel back to normal except for feeling like I've been in a fight.
I'm dosing my regular 6mg sub in the am. Sunday i'm going to try to decrease to 4mg since that has been my goal...we'll see how that goes.

Wow, its funny....when I was 22 I had all my wisdom teeth taken out, and an oral skin graft done (took graft from the roof of my mouth and grafted it to the bottom front tooth where there was a kind of receding gum line)...all done under local only. no pain meds, no sedation....and although it was a lot of blood and swelling it was not a big deal to me. Now, after years of being addicted off and on one little extraction turns into 3 days of posting!! Its just kinda silly in a way....when did I become such a wuss? LOL

But I hope this helps someone else who ends up going through this...I didn't realize how scary the idea of some kind of "surgery" and the issue of pain control would be until I had to face it...and it was scary....the pain I was in prior to the extraction seriously would have made me relapse had I not been waiting for the surgery...it was that bad. So this is a big deal to us...and the fact that it went fine...i don't think it would have been any different had I not ever been on sub...I've had them before and it was almost exactly the same. So, at least people can know that its possible to do some kind of minor procedure and get the relief they need. now, if it were a big abdominal surgery? I have no idea....


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PostPosted: Sat Apr 09, 2011 1:55 pm 
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Just one word of caution to others out there reading this thread- the max. daily dosage of acetominophen is 4000mg/day. At 7.5/500 x 9 you took 4500mg. I was in the same boat when I was prescribed 5/500's after my accident. Acetominophen overdose can cause liver failure. It's a wonder more of us didn't kill our livers when we were abusing pills.

It's too bad doctors can't take the time/interest to treat Sub patients properly and give us 60mg or more of oxycodone or it's equivalent without the APAP after surgery. But they're just not comfortable doing it. So we're faced with having to take enough low dose crap to kill our livers with the Acetominophen, it's crazy.


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PostPosted: Sat Apr 09, 2011 7:20 pm 
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Lillyval. that is such a good point. I mean, I guess doctors figure the stuff with the Tylenol is less dangerous, but it is actually more dangerous for someone likely to take more than the normal dose, and someone who has been on Sub has to take more to get relief. I know I probably damaged my liver with all the drinking I did. I'm so afraid to take any Tylenol at all. I've heard people tell stories of these massive amounts of pain killers whey ingested and, even though they were APAP, they apparently have no long-term damage to their livers. How is that possible? I guess Chinagirl put it perfectly....WHO KNOWS?

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PostPosted: Wed Nov 02, 2011 1:40 pm 
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Yes its really strange, I have a friend who got liver cirrhoses and he had a drink now and then but his friend who drinks day in day out doesn't have any liver problems. I guess it also depends on what foods you eat.


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PostPosted: Thu Nov 10, 2011 2:12 pm 
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laddertipper wrote:
Lillyval. that is such a good point. I mean, I guess doctors figure the stuff with the Tylenol is less dangerous, but it is actually more dangerous for someone likely to take more than the normal dose, and someone who has been on Sub has to take more to get relief. I know I probably damaged my liver with all the drinking I did. I'm so afraid to take any Tylenol at all. I've heard people tell stories of these massive amounts of pain killers whey ingested and, even though they were APAP, they apparently have no long-term damage to their livers. How is that possible? I guess Chinagirl put it perfectly....WHO KNOWS?

laddertipper


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PostPosted: Thu Nov 10, 2011 7:15 pm 
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Yeah only drawback to being on HDB (high dose buprenorphine/aka suboxone) has been dealing with acute pain. Last tooth ache I had was aweful. Ended up having to have it pulled after spending approx 24 hours in extreme pain. It was so bad I was literally rocking myself in the fetal position. I could only convince my Sub doctor at the time to give me permission to take an extra 4mg of buprenorphine and or try taking a 5mg hydrocodone tab every 4 hours. I really wish more people thought that opiate addicts don't deserve to suffer severe pain. I had a spinal fusion approx 7 years ago and I obviously didn't tell my surgeon at the time that I was using approx 100mg of oxy per day prior to the surgery. I literally spent the next 48 hours uncontrollably screaming in pain. The surgeon said he had given me the max amount of morphine that he could....... I should have told him before the surgery what was going on but he really seemed like the type of person that likely would have done the same thing either way. Last major tooth ache I had was while in recovery and I ended up having to have a tooth pulled. The only thing I was allowed to take was a 5mg hydrocodone every 4-6hours and or an extra 4mg of buprenorphine. I was already taking 8mgs a day though so the extra 4mgs did nothing. I really hope there was some way of educating more Drs to treat accute pain in people on buprenorphine maintenance

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