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PostPosted: Fri Oct 07, 2016 9:46 pm 
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I was scheduled for gallbladder surgery this past Thursday. My surgeon was fully aware that I took suboxone, but felt because I had successful knee surgery in the past it wouldn't be a problem. I was just about to go into the OR when the anesthesia Dr called it off. He said it was to risky to go forward while I had suboxone in my system. I was rescheduled and instructed to stop taking The subs 3 before surgery. I have 2 questions, 1 is 3 days long enough, 2 how long after the surgery can I start the subs back. I take 20 mg of subs per day. The plan is to give me fentanyl during the operation and maybe some more if I wake up in pain. Can anyone help with this? Does this all sound right?


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PostPosted: Fri Oct 07, 2016 11:39 pm 
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I want to post some information given to us by our resident physician who owns this site. Print it out or try to relay the information to your doctor.

suboxdoc
Post subject: Re: SurgeryPostPosted: Wed Aug 17, 2016 5:09 pm
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Here are the guidelines I give to surgeons who will be treating my patients:
http://suboxonetalkzone.com/surgery.pdf

And here is a blog post about the same: http://suboxonetalkzone.com/post-op-pain-on-suboxone/

If you go to http://www.suboxsearch.com , you can search either this blog or my forum for information. Just search either, at that site, for 'surgery' or 'post-op pain' or related keywords.

If nothing else, you can print the things you find and give them to your surgeon. Most docs out there refuse to learn about buprenorphine-- so patients need to play an active role in protecting themselves.

And another good one from the TalkZone:

http://suboxonetalkzone.com/category/acute-pain/

Rule

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PostPosted: Sat Oct 08, 2016 12:34 am 
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Thank you. I have realized that it is an uphill battle as a suboxone patient. It seems none of the Drs are educated about it, nor care. It blows my mind that none of them do their due diligence on a medication they know so little about. How is that even legal. I always get the answer of " Sorry I just don't see this a lot"


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PostPosted: Sat Oct 08, 2016 12:36 am 
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Those are excellent resources, Rule! Maybe you could post a sticky with that information on it?

Amy

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PostPosted: Sat Oct 08, 2016 8:38 am 
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I am not a medical professional but have had experience with having surgery. Gall bladder surgery is usually done with a laprascope (sorry about my spelling). My experience was that the pain was only a problem for the first 24 hours. I had minimal incision pain, but, had pain from the gas that they use in surgery to stretch my abdomen to provide better visability for the surgeon. I had my surgery at 11:00 am and was discharged between 2 and 2:30 pm. the same day. I was not yet an addict when I had this surgery.
I had major surgery while on suboxone at 12 mg. I was in the hospital for 6 days prior to surgery and chose not to take any suboxone. I was hoping to have less in my system to block pain medication. Post op I was on a dilaudid drip for 24 hours while in ICU which was very effective for pain. I spent 6 more days on a med surg floor on oral opiates. They first tried 2 5 mg oxycodone but they wore off totally after 2 1/2 hours and I was in terrific pain. They switched me to 20 mg of hydrocodone which work for almost 4 hours. Four days after my discharge from the hospital I resumed taking suboxone with no problems.
As I see it you have two things working against you. First you will be working against the blockade of your opiate receptors by the buprenorphine in your system. Second you have a high tolerance to opiates due to taking buprenorphine. I don't know how long you have been on the medication or anything else about your story. 20 mg of buprenorphine is more than most people take and seriously above the ceiling. I am assuming that you still had cravings at 16 mg hence you are on 20 mg. I would suggest that you work with your MD to combine dose decrease and or stopping for three days as you were told. You probably will need more pain medication than the typical surgery patient. They may need to keep you in the hospital longer to find a medication schedule that works for you. I would discuss this with the anesthesiologist prior to surgery to make sure that your pain is controlled and that they don't just prescribe the standard medication for you.


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PostPosted: Sat Oct 08, 2016 10:18 am 
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I have been on 20 mg for 5 years. Hopefully the 3 days off will be enough. Thank you for your responses.


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PostPosted: Sat Oct 08, 2016 11:22 am 
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The resources listed by Rule cover all of these problems, so definitely read through the information he provided then see if you have any more questions. Dr. Junig wrote all of the documents to help both the consumer and the surgeon. He is well known in his area for giving advice on how to provide suboxone patients with excellent pain relief.

Jeandianne, I remember that gas pain after my cesarean section! No one told me that I could suddenly feel gas pains in my shoulders the next day! I couldn't pick up my son to nurse him. It was terrible! Yuck! Plus I was only taking ibuprofen because I didn't want to pass any opiates to my son while nursing him. (It's funny to think back to when I was 27 and could refuse opiate pain medication without a second thought.)

Amy

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PostPosted: Sat Oct 08, 2016 12:09 pm 
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The point of my post was to strongly suggest that you DO NOT stop taking your Buprenorphine before surgery or you will get zero pain relief. I have been there and went through the worst pain of my life. Had I printed out these pages for my doctor it may have made a difference. Well, actually, no, it wouldn't have. My surgeon knew nothing about Buprenorphine and when I tried to talk about getting sufficient pain relief he brushed me off refusing to discuss it. My thought at the time was that he was judging me for being on Suboxone and considered me an addict that was too risky. So I suffered.

If I had to do it again, I would taper down just like Dr. Junig suggested and show my doc the paper, hoping he would understand my need for stronger pain meds.

Good luck on finding relief.

R

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PostPosted: Sat Oct 08, 2016 1:26 pm 
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I also had my gallbladder taken out before I was in active addiction, I was around 26 I think. It was done laparoscopic with 3 tiny incisions. The pain after wasn't too bad honestly, like everyone else said it's the gas that caused me the problems. It was in my shoulders which was very weird. I had no clue that could happen lol. From my experience, the pain wasn't bad enough that suboxone couldn't take care of. Now that's just me, others could be different. That's just something I wanted to share for ur post surgery. Hope all goes well.

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PostPosted: Sat Oct 08, 2016 2:06 pm 
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Sadie girl, if it were me, I'd consider reducing my suboxone down to a lower dose. And maybe think about staying at the lower dose if you feel you like it there. Girl 20 mgs is a very high dose, and if you read around here you'll see, almost every patient who takes Suboxone long term feels better on a lower dose. Just something to consider. I'm cutting back from 16 to 12 mgs just to give it a try and sure enough, when I take 16 mgs after being at 12 a couple of days, girl, I drag. And I regret going back up to 16 mgs for that day. Haven't had any problem, not 1 since going down, just a problem when I go back up energy wise. And I'm all about feeling good, having a lot of energy. Sorry to jump off topic here but I had to say something.
I'm sorry you are having to go through all that rescheduling and all with your surgery. I bet that is a pain. But the modulators have all given you good advice on the surgery issue. I take Suboxone for addiction and pain as well so think about what Jennjenn said about the Suboxone being strong enough to get you through. I don't know how your pain tolerance is and no one knows better that you what you are capable of handling so you have a lot of options here. I myself would be scared to get off the Suboxone and would probably just get down to a low dose and go through the surgery that way. But your Dr. doesn't want to go that rout. We are here for you, ok. Let us know how it went. You can always go back up to a higher dose after the surgery. Not sure how long you have to taper. It you have any questions about tapering down to a lower dose this is a wealth of information here in Stopping Suboxone and all through out. Good luck and I will be thinking about you.


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PostPosted: Sat Oct 08, 2016 2:36 pm 
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I am open to reducing my dose. I have just always takin this amount and don't really know anything else. I am sure it is all in my head, but I always feel if I don't take my subs at the same time everyday withdrawals will start. If I miss a dose I feel the beginning stages of withdrawal. That has been the hardest part for me, and why I have had trouble reducing down.


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PostPosted: Sat Oct 08, 2016 2:52 pm 
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When are you having surgery, hun? Do you take your Suboxone just 1 time a day? It might be easier to cut back if you dose twice a day. So if you are on 20 and want to cut back to 16 mgs, maybe take 8 mgs 2 times a day. Just an example. Hope your having a good weekend.


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PostPosted: Sat Oct 08, 2016 2:57 pm 
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I take 8 mg in the am, 4 mg in the afternoon, then 8 mg at night.


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PostPosted: Sat Oct 08, 2016 2:58 pm 
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The surgury is scheduled for October 31.


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PostPosted: Sat Oct 08, 2016 3:35 pm 
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It would help if you could get your dose down.
Ask your surgeon for a referral to a group that has experience dealing with Suboxone. Unfortunately you met an idiot. What would they have done if you had required emergency intervention? Wait 3 days? Probably just as well he walked away from you because I doubt if he would have had a clue as to how to handle peri-post op pain.
Staying on the Suboxone during the process allows you to take full agonist pain killers without the euphoria associated. As Rule's resources point out you need more than the opiate naïve patient. When done, you don't have to go through the induction process again to get back on the Suboxone.


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PostPosted: Sat Oct 08, 2016 11:33 pm 
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Great idea Amy, I did in fact post it as a sticky. But now we have two of them. One will fade away but the sticky will not.

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PostPosted: Sun Oct 09, 2016 4:02 pm 
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Sadie girl, if you want to try and cut your dose, try 8 morn, 4 midday and 4 night. Then after a few days maybe try 4 morn, 4 mid day and 4 night, then 4 , 2 and 2 if your brave or 4, 2, and 4. Play it by ear, I'm going kinda fast because you only have till the end of the month. But the good thing is, you HAVE till the end of the month to taper so make the best of it. And taper fairly fast if you can, remembering that you can always go back up dose wise when you've tapered down low enough to get the surgery. And a referral to a Dr. who has Suboxone experience is a wonderful idea. Do what you can girl and we are here for you to support you the whole way. hugs !!!! Angie


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PostPosted: Mon Oct 31, 2016 8:56 pm 
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Well today was the day. I ended up not taking my suboxone for 3 days prior to surgery. I did ask not to have any narcotics unless absolutely necessary. The surgeon was able to do the procedure laparoscopicly. The only pain med I was given was Toradol IV, it worked great! I resumed my suboxone about 3 hours after surgery. So far I am a bit sore, but it is manageable. I did not take my suboxone for 3 days as a back up plan. In the event I needed something stronger it would be available.


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PostPosted: Mon Oct 31, 2016 10:49 pm 
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Well congrats on your surgery and recovery Sadie. So you stopped the Suboxone three days out. Your pretty tuff I guess. Good for you.

While there are other ways to do it, it was your decision and it turned out fine. Glad to hear.
Thank you for leting us all know.



Razor


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PostPosted: Tue Nov 01, 2016 12:10 pm 
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I did decide to stop only because that is what my surgeon instructed. I would have rather reduced my dose, but I was advised that I must follow what my surgeon instructed. If anyone else has an elective surgury I would highly recommend printing out Dr J's info long in advance so all parties involved can read it and make a collective decision. I will say stopping for 3 days did not induce any significant withdrawals. More then likely that is due to how long and how much suboxone I take. Toradol was also a great non narcotic option, that really helped when I got out of the OR. I also resumed my suboxone right away that knocked the rest of the pain back.


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