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PostPosted: Wed May 02, 2012 11:01 am 
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Hi everyone!

I'd really appreciate it if you could read this and give me your opinions about my upcoming surgery, sorry if it's long...

 I have been on sub for about 2.5 years.  I was on 8mg the whole time but I have been slowly tapering since January.  Currently I am at 1.5 mg per day now and have been there for 3 weeks.  I am having surgery to remove a cholesteatoma which is a non cancerous tumor in my ear that has been blocking my hearing and generally making me nuts for some time! I have procrastinated this surgery because of sub but now I have to get it taken out.

This is an outpatient procedure and I am not super worried about post op pain.  The ENT surgeon said it shouldn't be too bad although they have to go in behind the ear.  I told him about my sub and related issues but he doesn't seem to really know much about it. he said I could recoup from the surgery with ibuprofen or Motrin.  He still gave me a script for 30 hydrocodone 5/500 which btw I could care less about--- how's that for sub?!!!  the old me would have chewed up 6 of them in the pharmacy parking lot!!

The concern I have is will they be able to properly knock me out for this thing?  Dr Junig's article here ... e-surgery/ suggests that I will be ok I think...

I am going to talk to the anesthesiologist beforehand and make sure they know about my sub and that I will have a huge tolerance to opioids so they have the extra supply on hand.  Would it make any difference if I stop the sub 3 days before surgery at this level if I am not concerned about post op pain?  I could stop the sub and take the lortab if I w/d but is that even necessary considering I am only on 1.5 mg sub per day?

Any other tips??

Thanks my friends,


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PostPosted: Wed May 02, 2012 1:15 pm 
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Yes, you could stop the bupe 3 days before and start the hydros if the w/d hit before the surgery (which it likely will with the low dose you're on). That's one of the ways to deal with treating acute pain in sub patients. See this thread for an NIH article on other ways to treat acute pain in sub (and methadone) patients:

You also might want to print out that article and have a couple copies on hand to share with your surgeon, sub doc, and/or anesthesiologist, especially if they have limited or no knowledge about suboxone. It's a great paper and NIH is an excellent source.

The suboxone won't interfere with general anesthesia, assuming that's what they'll be using.

If you do decide to use the hydros for a couple of days after the surgery, you only need wait about 12 hours before going back onto suboxone. You do NOT need to wait to be in withdrawals and do another full induction if you've only been on full agonists for a few days or less.

I hope this helps. Good luck with your surgery and let us know how it goes. If you have further questions, just let us know.

-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.

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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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