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PostPosted: Thu Feb 10, 2011 12:15 pm 
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Hey everyone!
I am looking for some advice about C-Section Surgery and Suboxone/Subutex. I am scheduled to go in Tuesday morning. My Sub doc told me to stop taking my Subutex 24hrs prior to surgery and I should be fine. The more I read the other posts in this catagory, the more I see people saying they stopped 3 day's or more before surgery. I am going to be awake for the c-sec, They will give me a spinal epidural (full block), and as far as pain management after I have asked that I NOT be given any Opiate pain relief, So I guess it'll be something like Motrin for the next couple of weeks. MY sub doc said that I can have a dose of Suboxone right after the C-Section, and I can just start taking my doses normal after that. He said that between the Sub's and the Motrin I should be fine as far as pain. This is my third C-Section, but it is my first on Sub's, and because I used Opiate pain relief in the past (24hrs of morphine, then 2-3 weeks of Loratab) I don't REALLY know what the pain is going to be like full-force.
I guess my questions are these:
"Will I be ok if I stop 24hrs before/will this effect the spinal block?"
"Will I be ok on just Sub's and Motrin after Surgery?"
"Has anyone out there had a C-Section on Sub's/ what did you do for pain after?"


***I greatly appreciate any in-put you all might have on this. All my doc's are telling me I will be fine with the plan I have made, but no-one seems to know for sure. I asked them all "what happens if I am in horrible, horrible pain after and I can't handle it?"...no-one can give me a definite answer on this!
Oh--BTW, my Sub's dose is 16mgs a day, in case your wondering..not sure if it matters.
Thanks!
Minx :D


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PostPosted: Thu Feb 10, 2011 12:57 pm 
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I can't speak to your question about the c-section, as I'm child-free, but I wanted to weigh in about surgery in general while on sub maintenance. Usually it's best to stop the suboxone 3 or so days before the procedure, BUT that's so one can get appropriate pain relief from full agonists. You know you can take opiates for surgery on suboxone, right? That said, many people have done so and still were unable to get any pain relief (because of the suboxone). I had a procedure last year though and was able to get pain relief. That said, I didn't feel any high whatsoever from those pain meds - just pain relief. And that's not unusual.) Since your plan is not to take pain meds/full agonists, I'm not sure why the doctor wants you to stop the sub 24 hours before - maybe just in case you decide to take something for the pain?

If you absolutely do not want full agonists to treat your pain, then it's best to dose more than once daily, as sub's pain properties only last on average about 6 hours. (Unlike the 37 hour half-life.) You could even up your dose of sub and take it 3 times a day to try to get maximum pain relief.

I hear you in that you do not want full agonists, but I had a hysterectomy years ago and I couldn't have handled that pain without taking pain meds. But I have no idea how comparable the pain is to that of a c-section though. I'm sure those here who have had them while on sub will come along and give you their experience. But personally, I just cannot imagine having nothing but suboxone after a major surgical procedure like that. But again, I know very little about c-sections.

Lastly, I hope this makes sense. I'm feeling poor today so I'm not at my best.

Good luck to you!

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 Post subject: Here's my experience
PostPosted: Thu Feb 10, 2011 1:16 pm 
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I was on 3 mg of Subutex during my pregnancy and planned to take no pain meds aside from Motrin after surgery. About a week before surgery, I had my last appointment with my OB, who had been following me very closely. He had the anesthesiologist on the phone and he talked to me and told me to stop my Sub. It was to be my third c-section as well, and I was also getting a tubal ligation. He said I needed to leave the possibility of pain medication open and he was adamant enough that I decided to take his advice. So, I stopped my Sub for a VERY uncomfortable week. He did not tell me anything about the Sub interacting with the spinal, which I also had. I don't see how Sub even could interact with a spinal block or how going off it for 24 prior would make a significant difference even if it did. 24 hours won't get the Sub out of your system. So, I think I had my c-section on the day that would have been my 7th day off Sub. The spinal went fine....very similar to the prior two c-sections. Afterward, I will be honest with you and say that I had more pain than I'd imagined I would have and I was grateful that I was able to take the pain meds. They gave me a LOT of Fentanyl after the surgery to knock the rest of the Sub off. I felt NOTHING from the Fentanyl, except itchy and a little relief from pain. It was like I was immune to pain meds or something. Then, they put me on a Dilaudid drip for a few days. That thing worked very well, as long as I wasn't being a martyr and actually pushed the stupid button. Once they took me off the drip, things went south for me. My tubal had been botched and they removed something that was not my tube. I don't know what it was, but it caused a lot of sharp and piercing pain on that side. They started giving me pain meds every 4 or 6 hours and I felt horrible. I was okay after a dose for about 15 minutes and then I was in w/d and pain and I was miserable. Then, they gave me a miraculous thing called Tordahl, which is not a narcotic. You really need to talk to your doctor about this stuff!!!!!! It was AMAZING!!!! It worked the best of anything, but they wouldn't give me a script to take home for some reason. They gave me Percocet, 2 strengths of Dilaudid...lots of pain meds. I was supposed to take the Dilaudid in between Percocet. Here's what I did. I left the hospital and I went back on my Sub and took Motrin and didn't take the pain meds. That pain med crap put me on such a miserable emotional roller coaster and I wanted off. I mean, I was a lunatic w/o my Sub and with those post-delivery hormonal changes.....AAAAHHHH!!!! LOL! It wasn't worth the 15 minutes of pain relief!!!!!!!! I took my Sub and my doctor told me to up it to 8 mg to relieve some of the pain and between that and the Motrin, I was good. I think if it hadn't have been for that botched tubal on my left, I could have made it through my surgery w/o pain meds, as long as I had my Tordahl and my Sub.

Good luck!!!! OMG, I'm rooting for you and your baby. PLLLEEEAAASSSEEEE come back on here and update or have someone do it for you!!!!!!!! Don't leave us hanging!!!!

laddertipper

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 Post subject: Thanks!
PostPosted: Thu Feb 10, 2011 3:25 pm 
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Ok--First I want to thank you both, Hatmaker510 and LadderTipper, for responding so quickly to my post! I am really nervous about this. I think what scares me the most is that it sounds like both of you gave yourself at least 3 days or more off of Sub's before surgery. It's too late for me to try for a week (I personally don't think I could go a week in WD's, under the best circumtances), I honestly think I would have trouble with 3 days. I am extremely sensitive when it comes to my meds, and it has been even more pronounced during pregnancy for me (I attribute this in part to crappy low quality generic Subutex), but part of it is me, and I know I would have a difficult time. 24 hours is doable, but it doesnt' sound like enough time to get the drug out of my system in the off chance I am screaming for pain relief in the recovery room. I can say that I did pretty good with the pain after my first and second C-Sections. I did'nt really need that much in the hospital, both times I asked to be taken off the morphine early, and once I got home I did'nt really need the pain med's after about 3 days (I still took them for 2-3 weeks, but I was'nt in recovery at that time, but I know that I did not NEED them for the pain anymore after about 3 days). So, that said, I think I am going to shoot for just taking my Sub's and Motrin, and hope to hell I don't need anything stronger. I don't think anything will work at this point anyway, so I am kind of stuck. I am also getting a tubal ligation done (WOW- we have a lot in common LadderTipper!), and after hearing your story I am really nervous about it now. I understand what happened to you is probably not the norm, but, holy shit! Man oh Man, if it was hard for you to get pain relief after 7 day's off--I am really going to be in trouble if anything goes south!!! All I can really do at this point is hope and pray everything goes well. It's kind of getting down to the wire and at best I might be able to give myself 3 day's off if I stop Saterday. I am going to try, and worst case I can just take a half tab if it's so unbearable. I suppose it still beats 24 hours. What was my doc thinking??? I will keep you all posted! Thanks again for everything! Oh BTW--I hope you feel better HatMaker510! :D
Thanks,
Minx


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PostPosted: Thu Feb 10, 2011 3:48 pm 
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As a nurse anesthetist I can address some of your issues but I have not had surgery myself while on Sub.
I would agree with what the other woman who had a spinal said about being open to getting pain meds postop. A c/s is not minor and it goes through some major muscle tissue which can be pretty painful postop as you know. I would stop the Sub maybe 2-3 days ahead of time and then be open to taking fentanyl and possibly dilaudid postop and then getting right back on your Sub regimen. It isn't a failure in your recovery and you deserve to have the best possible experience giving birth. Having your pain under control will allow you a much better bonding time with baby and also a much happier and successful nursing experience. Sub should NOT intefere with the spinal in anyway unless they are trying to use narcotics in the epidural or spinal...whichever they plan to use. Sometimes we use duramorph, sometimes fentanyl and that would be the only thing making the spinal "different".

If you don't need anything for pain postop then that's great. You can use motrin, but if you do you are not failing in your recovery because of it. And the other thing about pain control as most of jus know once you are chasing the pain it is much more difficult to get relief. If you go in with the mindset that you will use it for a couple of days, then let the doctor and nurses treat you I think your entire experience will be much more positive. You don't need to worry and you can focus on your baby and also be comfortable. if you are stressed and in pain the baby will feel that...either while nursing or while bonding.

Something that happened to me when I was in my first treatment was I needed oral surgery while in the middle of a 4 month residential treatment. I had finally gotten clean from opiates and did not want to take anything. But at that time and this was without sub, they had a plan where I got versed first so I wouldn't remember the fentanyl and then post procedure they gave me pain meds every four hours the first day....I didn't get a choice, it was just given. That way i got pain converage but it wasn't up to me when I thought I needed it. You can maybe do something similar and stay out of the "choice" and deciding if you need it....that takes some pressure off. just an idea...

And then go back on Sub after a couple of days...

It sounds like your anesthesia provider understands Sub??? If that is the case let him/her direct your care and you focus on your baby....Congratulations by the way!


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 Post subject: Here's what I would do
PostPosted: Thu Feb 10, 2011 4:10 pm 
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Well, first, I have to say with your statement regarding "what in the world was your doctor thinking." I'm wondering the same thing. You just have not been given proper guidance at all!!! You haven't had things explained to you properly. This is really disappointing to me. Even I saw a break in communication in my own experience that made it all much harder. My doctor went along with the "no pain meds" plan for my entire pregnancy, knowing I'd be getting a c-section and a tubal. Only one week before, he decides to call the anesthesiologist and change my whole plan to where I basically had to jump at 3 mg? That was ridiculous. I got seriously sick during that week off Sub. In fact, I went into labor and was dilated to 7 by the time I got to the hospital. However, the w/d was such a pain that I didn't even care about the labor. And my baby was breach, so I couldn't just push her out, especially since I'd already had two c-sections. I would hope that by now, three years later, things would be better planned out for women. I think you need to call the anesthesiologist and speak directly with him/her. Ask what can be done to knock the Sub off IF you have much more pain that you anticipated. Ask why it's necessary to discontinue your Sub for 24 hours. To me, that makes no sense at all. Ask if discontinuing your Sub is even safe. DON'T stop it early unless you are assured it is!!!!!! I don't want your baby to be harmed because you are trying to stop the Sub more than 24 hours ahead. PLEASE listen to me on that one!!!! It's really, really important!!!!!!!!!!! Ask the anesthesiologist about 'toradol', which is the correct way to spell it, as I just looked it up. Tell him your fears. You should go into this feelings like you have all your bases covered. Have you toured the NICU and met the doctors there? Have you had it explained to you how they treat babies with NAS? I know that may seem scary to consider, but I promise you, once they explain exactly how they get your baby from sick to healthy and home with you, you have just looked your greatest fear in the face and it won't feel so scary anymore.

As far as the pain goes, if I try really hard to put myself back there, I think I have to kind of agree with Hat about the pain thing. It gets tough to remember whether it was bad or not and to gauge if I could have handled it w/o pain meds. It's easy to say now that it wasn't that bad. I remember thinking "Thank God I can take pain meds because I forgot how much this hurt!" A lot of it was the tubal botch, but c-sections are major surgery and the first few days hurt. After that, it's not bad. That said, I know the effectiveness of that Toradol stuff amazed me. You just HAVE to figure out what your options are and the only way to know is to talk directly to the anesthesiologist yourself. Tell your doctor you have a lot of questions and it's not okay to have him go ask and then report back to you. Anesthesiologists understand Sub a whole lot better than other doctors. Ask him if he CAN knock the Sub off just in case, and if he can't, then just look at the other alternatives and tell yourself this is what you have to do and you will do it.

Seriously, I'm so sorry I brought up the botched tubal. I feel bad for scaring you. It was such a freak accident. The doctor was shocked. There were numerous people in there watching the surgery and no one caught it. It just never happens. Don't think it will happen to you. I think you have a better chance of getting struck by lightening. The thing I'm worried the most about for you is that (1) you have so many unanswered questions and you need to know what is best for both you and your baby; (2) I'm worried you will drop your dose or discontinue it without the doctor knowing and that it could harm your baby. Please don't do that!!!

I'm praying for you!! Your baby is almost here. I wish you didn't have to deal with these fears right now.

laddertipper

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PostPosted: Thu Feb 10, 2011 4:59 pm 
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Just another thing...If pain meds alone aren't helping enough and keeping you out of withdrawals, the doctors can give you a small dose of suboxone along with it. There's a couple of studies/papers in the "Links" section on the index page, one of them talks about different pain control options. The one I'm thinking of is called something like "Treating acute pain in Sub/methadone patients". You should absolutely read that paper and maybe give it to your doctor, if s/he isn't used to dealing with sub patients. It's been extremely helpful to many of us who have had surgeries. Good luck to you.

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 Post subject: One more thing...
PostPosted: Thu Feb 10, 2011 8:56 pm 
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I have been reading all your post's (thanks so much!) and I just wanted to add that I did have a meeting, albeit brief, with the anastisioligist. He said that he is familiar with Suboxone, and that he has worked on many patients on it in the past succesfully. He did'nt go into specifics about the pain meds they use, but he said that they have some "short acting" pain med's that they often use post-op, and then depending on the patient they can sometimes resume their Sub's right away or within a few days. I told him my plan (stop sub's 24 hrs prior/ take sub's immediatly after with Motrin) and his response was more or less "we will play it by ear/see how you feel in the recovery room. If you need stronger pain mangement we are prepared for that". Like I said, this meeting was very brief, and he was not really specific about the drug's they planned to use. I guess part of the reason that I was so opposed to using Opiates for pain relief was because I felt like on some level I would be compromising my sobriety. I will have 2 years completley clean in March of this year, no slips, I havent' even had a sip of OTC cough syrup, and I felt like if I ever put that garbage back in my body ever again than it's like a "relapse". I know rationally that this is silly, but that was how I thought about it when I was deciding how the surgery would play out. Now, after reading the post's here for the last couple off weeks and spending some time really thinking it over, I know that I was being really naive to think I could possibly go through this with nothing but Ibuprofin! And ChinaGirl is absolutly right, I should be able to relax and enjoy my new baby boy and the first day's with him, instead of being stressed out and uncomfortable. I just want to clarify before I end, I do not think that taking Opiates after surgery is relapse. That was a silly notion, I don't know how/why I thought that way, and I am open to following the reccomendations of the doctors/staff at the hospital as far as my pain level goes. I am going to see my OBGYN once more on Monday morning, the day before surgery, so I am going to talk with her about all of this again and let her know that I have changed my mind about pain meds. LadderTipper had asked about if I had a chance to meet with the NICU doc's; I did'nt see any staff from the NICU, but I did meet with my son's Pediatrician last week to discuss NAS, and he has put my mind at ease a lot and answered all of my questions. He has experience with infants and NAS, the group of physicians I use for my children is actually the residency program through the hospital I am delivering at, so there is always someone available from the practice on the labor/delivery floor as well as the NICU. They are all excellent doctors, I have been using their practice since my oldest son was born 9 years ago and I have the utmost confidence in them. I will continue to post as much as possible and keep you all up-dated on how the delivery goes. Thanks again for everything, I think I would be lost without all your advice. I feel like I am going into this much more prepared, and that gives me a lot more confidence that things will go well.
BTW--I am going to ask about that medication you reccomended LadderTipper!
Thanks!!!
Minx


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PostPosted: Fri Feb 11, 2011 1:47 pm 
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Hi again, glad you spoke to the anesthesiologist...sounds like he was very vague but that he feels he knows what to do. The short acting opiate he is talking about is most likely Fentanyl. It is 100times more potent then Morphine and will kick the sub off and hopefully help you. I'm really happy that you believe you will not be relapsing if you decide to take pain meds. You aren't! And maybe you won't even need them...Toradol might be a good option...it is just a much stronger nsaid (nonsteroidal anti inflammatory) and helps with more moderate pain at times. Most likely he will give that to you at the end of the delivery...

Congratulations on your 2 years clean! THat is awesome. I think things will go well for you on Tuesday and let us know how you are doing. Keep posting and talking about your concerns....this IS a big deal and it's great you have a lot of support.


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 Post subject: That's good news
PostPosted: Fri Feb 11, 2011 3:21 pm 
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It sounds like things are actually being handled just fine and let me just congratulate you...you are about to have a baby and I'm so excited for you!!!! I miss my kids being little. You are going to get that sweet baby smell in your house again and those chills up and down your spine when you look at him and realize how much you LOVE HIM!!!!

Here's a thought. IF you need pain meds, like you said, it is not relapsing. I'm glad you realize that. So, if you do and they knock the Sub off with Fentanyl, I strongly recommend you request a pain drip. It works because it is a small amount at a time but given very frequently. The oral ones put me into w/d, but as long as I had the drip I was fine. Also, I didn't feel anything but pain relief. It was so good at dealing with the pain without making me loopy that I kept thinking I HAD no pain and didn't need to push the button, lol. Hint: Push that button! You cannot push it too much. They won't let you. If you can stay on a drip for a few days to get through the bad part, you should be able to go onto Toradol after that and be fine until discharged and you should also be able to restart you Sub. They would only leave my drip in three days, I think. I had another three days of oral pain meds and they were not good days at all because of the w/d. Just my experience. It may not even apply because you may not even need pain meds!! That toradol stuff is mighty effective. You can do this!!!!! You're having a baby!!!! Woohoooo!!!!!! I cannot wait to hear your birth story. :D

laddertipper

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 Post subject: congrats on your baby
PostPosted: Thu Feb 17, 2011 10:14 pm 
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I'm sure posting is the last thing on your mind right now....but you hopefully had a really great experience on Tuesday with your C/S and congratulations on the birth of your baby.
When you are feeling up to it let us know how you are doing....
Chinagirl


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