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PostPosted: Tue Mar 01, 2016 7:18 pm 
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Hi everyone!

I'm actually have surgery tomorrow and I infrom the nurse coordinator about me being on subs. They told me to infrom the doctor in the morning before surgery. I'm actually on low dose subs. I always been on low does. I started at 1mg the first time on subs now I'm currently on .50-.75 mg of subs a day. I have tapper down a little bit.

Have anyone been on low dose subs and have the pain meds work during surgery?

Thanks for your response!


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PostPosted: Tue Mar 01, 2016 10:05 pm 
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During surgery or do you more mean after surgery? During surgery sub should not effect things at all. The medications used to put you to sleep will not get blocked by sub.

As for pain relief after surgery, you will likely need twice the regular dose. So if the surgeon typically provides 5 mg of oxy or 7.5 mg of hydrocodone (extra strength) you will need 10 or 15 mg respectively. I recently had wisdom teeth removed while on about 1i.5 mg of sub and did just fine with pain relief. Dr. Junig who owns this board does this with patients all the time with very good luck. You can continue to take your regular dose of sub and then never have to stop sub or reinduct. It works very well. Just be certain to tell not only the surgeon but the recovery staff. Things sometimes don't get relayed so go over it with all staff treating you.

You will be just fine on your low dose. Just make sure the surgeon fully understands.


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PostPosted: Tue Mar 01, 2016 11:16 pm 
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Thank you for the input!. Yeah I actually meant post surgery lol. Thanks for heads up, I'll make sure to let them know.


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PostPosted: Tue Mar 01, 2016 11:33 pm 
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I would also like to counsel you to make sure that the post-op nurses know that you are opiate tolerant. I woke up in a lot of pain after a surgery because the nurses didn't know to give me extra/stronger opiates.

Good luck!

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PostPosted: Wed Mar 02, 2016 9:51 pm 
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Thanks, Don, for sharing that. This is what I typically give to my own patients who have surgery, while on buprenorphine: http://suboxonetalkzone.com/surgery.pdf

There are a couple opinions out there, and mine (for some reason!!) is in the minority. What I read out there the most is to stop bupe completely, either a couple weeks in advance, or starting the day of surgery-- and then to treat pain like you would 'normally'. My problems with those ideas are that stopping in advance is a ridiculous idea, put forward by people who obviously have NO idea what opioid withdrawal consists of!! Do they really WANT people to go into surgery depressed, weakened, and dehydrated?! Do they really think that most people can even pull that off?

The idea of stopping on the day of surgery is a little better... but my problem with that is that it takes a couple weeks for bupe to leave the person's system. The patient will be laying there in pain, asking for help, and nobody will remember that the person is a buprenorphine patient who needs EXTRA narcotic. I like to leave the bupe in place, or maybe leave it at a reduced dose-- as that serves as a reminder to everyone that the person has an opioid blocker in his/her system-- so regular doses of narcotic will NOT WORK.

Like Don H said, it takes 2-3 times more narcotic to treat pain in bupe patients. Morphine is NOT a good choice, as it releases histamine in higher doses, and is too weak to out-compete buprenorphine. The person should get fentanyl, oxycodone, or dilaudid-- in doses about 2-3 times higher than in non-bupe patients.... and sometimes even HIGHER. I had a patient who had shoulder surgery 3 times in one month, and she needed 30 mg of oxycodone every 4 hours to tolerate physical therapy. The nice thing about staying on bupe is that when she was done with the PT, she simply stopped the oxycodone and continued the buprenorphine. In people who stop bupe completely, tolerance escalates RAPIDLY, towards the sky.... and then they must be 're-induced' to get back on buprenorphine.

Again, here is the link-- feel free to share it with your doc: http://suboxonetalkzone.com/surgery.pdf


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PostPosted: Thu Mar 03, 2016 3:30 am 
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My doctor (I know I've mentioned him to you quite a bit) seems to be the area expert on how to deal with pain after surgery for bupe patients. I was on 3mg of bupe per day when I had a surgical procedure. Dr. Edrich kept me on the same dose of bupe, advised my surgeon to prescribe twice the amount of oxycodone as usual, plus he gave me 15 extra 2mg strips for the month to help with any additional pain. I told him my plan to speak with the surgeon and the anesthesiologist on the day of the surgery. The only people I neglected to speak to, because I didn't think of it, were the post op nurses who failed to give me enough pain medication via IV after the surgery. Since they would only push pain meds every 5 minutes it took about 25 minutes for them to get to a pain relieving level of medication. I was too out of it to tell them I was on sub and therefore opiate tolerant.

I always wish that you, Dr. Junig, and my Dr. Edrich could be in touch. But you're both so busy I don't know that you both would find time! I think it would be helpful to patients, however, if there were a forum for sub prescribing doctors. I know that Dr. Edrich is interested in networking. Perhaps you could add a physician-only section of the forum for just that purpose!

Amy

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PostPosted: Thu Mar 03, 2016 1:23 pm 
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I had 3 surgeries while I was on sub. I was tapering so my doses were approx 1.5mg, .75mg and <.5mg respectively. I never stopped or lowered my dose for the surgeries.

It was kind of a crapshoot. I told everyone about the sub in all cases, printed out Dr. Junigs reccomended papers etc.. but it really depends on the nurses and Dr. after the surgery. The anesthesiologist is going to keep you knocked out no matter what. While in my recovery bed one surgery was fine it was a very long 5 hour surgery tho so I was probably pretty drugged up, I didn't have to ask for additional meds. The second was a quicker surgery and I did have to ask for more until the pain was tolerable but they were understanding. The 3rd was at a different hospital and I kept begging for them to stop the pain and the nurse would give me 1 5mg vicodin by mouth every 25 mins or so and I had to demand the Dr. come because it was not acceptable and I was very much in pain. He had to sign off on dilaudid injection which immediately worked. Of course that was a pretty demeaning experience but not the end of the world.

Also, the weeks following the surgeries I was just given the typical 20 or 25qty 5mg vicodin or percoset w/ no refill and just took as prescribed along with my sub and then switched to tylenol if needed. It was fine.

It's really unfortunate how so many doctors and medical professionals don't know about buprenorphine and have so many misconceptions because it was a VERY large part of my recovery from active addiction and I'm not sure I would have been able otherwise.


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PostPosted: Fri Apr 15, 2016 8:12 am 
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Hi. I've been on suboxone for about 2yrs now for chronic pain control. OK so first off, you CANNOT take suboxone if you're about to have surgery. It will block the meds & make u sick. I had 2 surgeries last yr and I made my Dr give me SUBUTEX before & after surgery plus pain pills. The subutex is a bit different in that there's no naloxone. So if you are getting surgery I suggest asking for subutex at least 3 days before & after so the meds will work a little better. Now buphenorine still blocks opiates but at least the naloxone won't make u sick. Trust me. I went thru it. So good luck & hope that helps. Oh and after you're ready to get back on suboxone, take subutex for at least 72hrs after your last pain pill. Easier transition. I don't get why Dr's don't understand that going straight from an opiate to suboxone makes you very sick. There is an easier way people. It's called subutex.


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PostPosted: Fri Apr 15, 2016 9:30 am 
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Subsgirl36:
It is fine to take Suboxone pre and post op. If the dose is high you may not get much pain relief with full agonist but it won't make you sick. If the Suboxone dose is less than 4 you can get adequate pain relief. I have had several patients do exactly that and did fine. A mg of Naloxone sublingual will not have any effect with other meds.
If you had problems it was for another reason.

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I don't get why Dr's don't understand that going straight from an opiate to suboxone makes you very sick. There is an easier way people. It's called subutex


That is incorrect. Induction can be with either. If you give subutex too early the precipitated withdrawal is the same as with Suboxone.


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PostPosted: Fri Apr 15, 2016 8:44 pm 
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Subs girl, with all due respect, you clearly don't understand what you're talking about. If a person is going to get precipitated withdrawals from suboxone - buprenorphine/naloxone, they will get the same precipitated withdrawal from subutex. The naloxone is not at all a factor. When taken sublingual, it does not get absorbed and metabolized. It is very possible to have surgery while on bup. In fact, you can stay on a low dose of bup (suboxone or subutex) and just take higher doses of Opiates for pain. I'm not sure why you think otherwise, but it's simply not true. Somehow you've become misinformed. Please don't misinform others as well.


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PostPosted: Fri Jun 10, 2016 3:34 pm 
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Hi everyone, I'm new to this but I have a question maybe one of you can help me with. How long does it take to get suboxone out of your system? I've been on suboxone for about 2 years now, and my dosage is 8/2 strips 3 times a day. I have to have a knee replacement very soon and I need to get off so that I can take the pain medication needed. I'm going to try to stay off the sub. after the surgery, but not sure how good i'll do coming off the pain meds. My husband will be watching me like a hawk, making sure I don't take more than I should. I'm very nervous about the whole thing, getting off the suboxone, the knee surgery, and especially taking pain meds again. So if anyone can tell me how long I have to be off of them to be able to have the pain meds work, I would really appreciate anyone's help.

Thanks


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PostPosted: Fri Jun 10, 2016 4:04 pm 
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Hi Birdy, I moved your post over here because I thought it very important that you get the right kind of feedback! I can tell you, I had a procedure done back in March. I met with the head of anesthesiaolgy and discussed my concerns about being on suboxone. They knew that if I was in pain they would need to give me a higher dosage of pain medication. As it turned out, I was not in more pain than tylenol could handle. I hope that you get more responses that address your concerns.


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