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PostPosted: Fri Jan 21, 2011 9:22 am 
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I have been using opiates most of my life. Both illicit drugs (found out about heroin in Vietnam) in my younger years and the legal type from doctors & pain management centers (oxy's, vic's & other types) for over 12 years because of chronic pain from multiple spinal surgeries and other health issues. Back in June I talked to a surgeon about having an anterior sub-muscular transposition of the Ulnar nerve. Looking it up on the Internet & seeing it done on YouTube, it seemed quite painful, so I was was quite concerned. At the end of September 2010, I started reducing the amount of Suboxone and got it down to 8 mg by the beginning of December, 2010. The doctor at the rehab clinic where I get the Suboxone told me just not to take it the day of the surgery (Jan 17, 2011). Reading all the forums on the Internet and some studies even by the manufacturers stating that you should be off of it for at least 7 days had me worried.I decided to take my last dose on Friday at 4 PM. My surgery was scheduled for 8 AM on Monday. I was just starting to feel that the effects of withdrawal Monday morning. It wasn't bad at all. I brought a sheet of paper with me with the following on it (below) and showed it to the anesthesiologist. The naloxone in Suboxone is not the problem. It's the Buprenorphine that's the problem.

[b]I made it a point to tell him that I've been completely opiate tolerant for over 12 years and that Buprenorphine is a partial agonist at the mu receptor. It is very important to tell the anesthesiologist exactly these words.[/b]

I was lucky, he knew exactly what I was talking about and told me not to worry about having any pain during the operation, that he would make me comfortable. He said that after the operation was when I should worry about the pain and talk to my surgeon. I had already told my surgeon that I was opiate tolerant and would be in withdrawal when I came into the hospital. I should have reminded him because I was a little disappointed when he just wrote me a script for Vicodin because I wasn't sure if it would be strong enough. During the operation, the anesthesiologist gave me fentanyl and morphine. I remember waking up in the recovery room and I was in a lot of pain but as the nurse later said, they gave me a boatload of pain medication to make the pain go away. I do remember saying twice that I didn't feel any lessening of the pain and then I was out like a light again. So I didn't get out the recovery room until about 12 noon. When I got home and got the prescription filled, I took 2 Vicodin every four hours for the first day. It said to take 1-2 every 4-6 hours. The next two days, I didn't need that much. I never got high from all the meds but it did relieve the pain. All the Vicodin did was make me nauseous and groggy (instead of nodding) and I actually look forward to getting off of it and getting back on the Suboxone. I also took Ibuprofen along with the Vicodin after the first day and it really helped. So after about 12 hours after the last dose of Vicodin (Wednesday) I took a Suboxone with no ill effects. I hope my story will help someone out there that is worried about having surgery. I still need to hqave my right arm operated on so I plan on taking 8mg of Suboxone until I make it through that. Then I'll start weening off of it so I can have a "clean" date again. Or maybe not, it works well for my pain and I don't have any cravings so I'm not sure what I will do.

The following is what I printed and I made multiple copies to hand to all the care givers so they would understand:

Suboxone 8/2 8mg buprenorphine / 2mg naloxone

Buprenorphine is ‘a partial agonist at the mu receptor’ .

"I have been completely opiate tolerant for over 12 years." Was under the care of a Pain Management Center for chronic pain. "I am now on Suboxone, a medication that blocks the opiate receptors in my body". I have been on 32mg since Dec 2009 to Sept 2010. I have reduced to 8mg Sept 30 2010 till now.
Last dose (8mg was Friday 4 pm)
Buprenorphine (trade names Suboxone and Subutex, Reckitt Benckiser Pharmaceuticals, Inc., Richmond, VA) is currently used for the management of pain, in addition to opioid and heroin addiction. Institutional data indicate that the number of patients presenting for surgery taking buprenorphine is rapidly increasing due to increased use by pain practitioners and primary care physicians in our community.

Buprenorphine is a partial agonist/antagonist with a very long half life and tight receptor binding. As such, its effects can inhibit the efficacy of traditional opioids in the post-operative course. This can lead to uncontrolled pain and the potential for seriousadverse events.


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PostPosted: Fri Jan 21, 2011 11:44 am 
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My experience was very similar.


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PostPosted: Fri Jan 21, 2011 12:22 pm 
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You deserve two thumbs up. You handled that very responsibly. I'm pretty surprised that the Vicodin kept you feeling decent. My experience was that (after not taking any Sub for a week before surgery) I was okay (except for the w/d which sucked) until they switched me from the pain drip to oral meds, which were every 4 hours. I felt awful then, okay for maybe 1/2 hour or so and then both pain AND w/d for the rest of the time until I could take more pain meds. I didn't double up, just because I'm always scared of the Tylenol poisoning me or something. I switched back to Suboxone when I got home to be normal again. That and Motrin held me. It's nerve-wracking having surgery and having to deal with the Sub on top of it. Now I wouldn't be so scared but I certainly was back then.

laddertipper

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First you take a drink, then the drink takes a drink, then the drink takes you. ~F. Scott Fitzgerald


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PostPosted: Fri Jan 21, 2011 1:17 pm 
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Like Ladder, I too am very surprised that your pain was held with one or two Vicodin. I am 10000000% positive that you were given the exact same script that all other patients were. Taking 1 to 2 Vicodin every 4 to 6 hours is a very standard regimen. It is the standard. Those who are tolerant on opiates need two main things - they need more opiates - as in higher doses, and more frequent doses. From what I have read, the starting point is often 10 mg of oxycodone every two hours - yet you were given less than half of that.

I just don't know what else to do with these doctors. This story reads like so many others. I can't tell you how many times I have read the following:

1: "Stop your Suboxone the day of the surgery"
2. "Don't worry; we'll take care of your pain"
3. "We gave you a truckload of pain medication" (or we gave you enough to known out an Elephant/Horse/Gorilla/Insert really large animal here.)

And the end result is nearly always "It didn't touch my pain" or "I was still in severe pain"

Why can't doctors at least get better at this? This stop your Suboxone the day of stuff needs to stop. I have yet to hear from any Sub patient taking a "typical" dose who feels any withdrawals until the third day. They feel very normal 24 and very often 48 hours after their last dose. Yet doctors keep saying the day of. They claim they understand and will provide the needed pain meds yet they don't give anything more than they give to any of their other patients that day. Some give LESS. A few give NOTHING.

What's worse, I see many of these patients try to do all they can. They try to inform their healthcare staff. They try to bring in information. They take it upon themselves to try to get into withdrawals rather than stopping the day of surgery.

I'm glad that it worked out for you. I just fear, that you were lucky. If I had to guess, the procedure was not as painful as you thought it was going to be. Because based on everything you told us, the amount of Vicodin you were given likely did not do much of anything for you. Your body just was not as injured by the surgery as you thought it was going to be, and therefore you didn't have a high level of pain.

Just my thoughts.


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PostPosted: Fri Jan 21, 2011 1:36 pm 
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When I was released, after my horrible experience, I was taken off a morphine pump and oxycontin 80mg 2x/day and given scripts for norco and oxy 10mg 2x/day. I had questioned being able to maintain with such a drastic cut, let alone get any pain relief, and was offered nothing else. I slowly went into WD and ended up re-starting my suboxone on my own initiative. I thought I did everything correctly.....but in the end, you only get what they give you. I remember (vividly) being wheeled into the OR and being completely lucid....yet they told me I could not be given more pre-op meds.


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