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How would you prefer to manage Suboxone for surgery?
Poll ended at Sat Jul 18, 2009 5:23 am
Stop Suboxone, take hydrocodone, etc, restart Suboxone later. 14%  14%  [ 1 ]
Continue Suboxone at lower dose, take hydrocodone, increase Suboxone after hyrdocodone stopped, taper dose back down. 86%  86%  [ 6 ]
Total votes : 7
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 Post subject: Surgery and Suboxone
PostPosted: Thu Jun 18, 2009 5:23 am 
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I've been prescribing Suboxone for five years and have had many patients who have had painful procedures from a root canal to ankle fusion to gall bladder removal. The common wisdom is to stop Suboxone five days before surgery, manage pain with the usual opiates through and after surgery, stop opiates and begin Suboxone again. I've never liked this method since it leaves patients open to relapse and have seen it happen to some managed in the traditional, recommended manner. I prefer to cut back on the dose of Suboxone for several days before surgery but continue it during and after surgery. Then I ask the surgeon to leave the post-op pain management to me after a few tablets of something such as Vicodin ES or HP are prescribed at discharge and recommend a higher dose than would normally be used (to overcome the partial antagonist property of buprenorphine). I quickly discontinue the traditional opiates and if necessary treat any ongoing pain with increased doses of Suboxone (for up to a week). At this point, I taper the dose rapidly to what it was before surgery for maintenance. As I said, I've had great success with this method, have not lost any patients to relapse and kept my patients as comfortable as would be possible (and usually more so than with the traditional opiates when discontinuing Suboxone before the surgery). A significant part of my practice is pain management, especially for those in recovery for both short term pain (surgery, injury) and long term pain (such as arthritis, fibromyalgia, chronic back pain, etc. In my experience, the pain management is better when using Suboxone than any of the other opioids. Even for those who never had a problem with opiate dependence/abuse but just didn't like how hydrocodone or oxycodone made them feel. (You know, those folks who get spaced out and sleepy when they take Vicodin, not the energized, supercharged effect we all seem to get). One patient who took OxyContin 20 mg BID for severe arthritis not only concerned her family because she was so out of it she couldn't function, but also had pain rated at 6-7 out of 10 at best. Now taking Suboxone her pain is 3-4/10 on average and on really bad days reaches 6-7. OK, this is getting long and I just want to let folks know there are other options for pain management I consider less risky to recovery than the popular wisdom.
Greg Haines, M.D.
Treat Addiction/Save Lives


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PostPosted: Thu Jun 18, 2009 6:55 am 
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Thanks so much doc for sharing your experience with us I sure think the pre and post op management sounds a whole heck of alot better to me than discontinuing Sub for 5 days?!?! (holy crap) I've really been wondering what to do about my grandpa who had surgery on a broken hip awhile back that never seemed to heal correctly/completely he's been on some pretty heavy duty pain meds and he's been experiencing major cognitive functioning problems. We even had to recently move him into assisted living and while I'm sure it's not just the opiates he's taking (oxycodone/contin) I can't help but think he would do alot better on bupe or at least he'd be less of a space cadet. It's good to know bupe could manage chronic pain that well.
Thanks again,
Matt

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PostPosted: Thu Jun 18, 2009 12:58 pm 
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Hey Dr. Haines,

Welcome to the forum!

I saw a post a while back from Dr. Junig mentioning that he had used Oxycodone in combination with Suboxone for the treatment of pain. If I am correct, the patient did in fact get analgesia but no euphoria. You'd have to ask him regarding the Suboxone dose, Oxycodone dose, etc.

If I find the post or article I'll put it here for you to see.

[EDIT]

I found a post from Dr. Junig where he was discussing different options for someone in chronic pain.

http://suboxforum.com/viewtopic.php?t=230

--Jim

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PostPosted: Thu Jun 18, 2009 11:01 pm 
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That is some good information to know Dr. Haines. Thanks for taking the time to share.

I wish that all docs were as informed and understanding as you and Dr. Junig. Unfortunately it seems that more often than not they don't know about Suboxone or they are unwilling to treat our pain if we are taking Sub. I had a kidney stone about 6 months into my Sub treatment and sitting there in the ER in incredible pain I was still debating: Should I Tell Them?

I didn't, and lucky for me things worked out ok. My best friend had to have serious oral surgery, and she was afaid to tell the surgeons. She lucked out though and they gave her adequate pain meds after her surgery. She did tell her Sub doc what was going on and transitioned back to Sub just fine.

I found that the percoset worked better if I took it with a smaller dose of Suboxone. Then when I passed the stone I just went back on my normal Sub dose and everything was fine. My Sub doc was suprised that I could get any effect from the percs but now he knows.

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
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