It is currently Wed Aug 23, 2017 7:48 am



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 11 posts ] 
Author Message
PostPosted: Sun Apr 16, 2017 7:36 pm 
Offline
New Poster
New Poster

Joined: Sun Apr 16, 2017 7:34 pm
Posts: 2
Hi there, I am on 24mg a day of sublingual suboxone with naloxone (12-3mg). I am having major back surgery in 4 days. My Dr. told me to taper like so, 18mg 4 days before, 12mg 3 days before, 12mg 2 days before and 6mg 1 day before surgery and nothing day of. From what I have read this seems like it will not work well for pain management post surgery unless major amounts of meds are given. Does this seem like a good taper and my pain will be able to be controlled or if I stop completely 3 days before would that be better? If I could introduce pain medicine prior to the surgery would that be better or what. I know its short notice but I was under the assumption the Dr. would guide me properly and now I am really scared. I don't want to have uncontrolled pain. Thanks in advance.


Top
 Profile  
 
PostPosted: Sun Apr 16, 2017 8:07 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
I'm sorry, but I do not believe your plan wil work. There are two approaches to dealing with post-op pain. One is to eliminate buprenorphine and use agonists like oxycodone; the other is to continue buprenorphine and take agonists in addition to the buprenorphine.

I like the second, because it is easier to simply restart the buprenorphine when the need for opioids has passed. If the patient stops buprenorphine, he/she will still have a high tolerance, and will come to surgery in the midst of withdrawal symptoms.

There may be specific features of your situation that favor the approach used by your doctor. I tend to do what I describe here: http://suboxonetalkzone.com/surgery.pdf

There is a 'consensus statement' put out by NIH that describes the two approaches, and I discuss them here: http://suboxonetalkzone.com/post-op-pain-on-suboxone-2/

I have the NIH paper at my office; I'll try to get it uploaded so that you can access it.


Top
 Profile  
 
PostPosted: Sun Apr 16, 2017 8:13 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
Just found it. You can access it here: http://suboxonetalkzone.com/bupe.postop.pain.pdf

I usually continue buprenorphine, and treat pain with oxycodone 15-20 mg every 3 hours. Whatever you do, you will need pain medication beyond buprenorphine(!). Even if you stop buprenorphine, your tolerance is much higher than usual, and your taper will leave significant buprenorphine around, blocking your receptors. Make sure your doc knows that you WILL need opioids!!!


Top
 Profile  
 
Our Sponsors
PostPosted: Sun Apr 16, 2017 8:39 pm 
Offline
New Poster
New Poster

Joined: Sun Apr 16, 2017 7:34 pm
Posts: 2
Thank you so much for the quick reply. I will be discussing with surgeon and sub Dr first thing in the AM. I hope they agree to keep my on the low dose suboxone with added oxycodone however I fear they won't.

I just hope whatever they do they keep my pain under control. I am going to do all I can to educate until surgery and then pray for the best.


Top
 Profile  
 
PostPosted: Tue Apr 18, 2017 11:31 am 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2802
Location: Southwest
The only problem you may face is your doctor not believing the facts about Buprenorphine. Print out some documents to bring with you backing up your statements. Some doctors don't like being corrected by their patients. Go at it a different way like saying you did some research and here is what you found.

I don't even want to go into the horror story I went through back in 2011, but times have changed and physicians are learning more and more about Buprenorphine. Hopefully yours has too.

May you have a speedy recovery!

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
PostPosted: Sat May 27, 2017 12:02 pm 
Offline
Average Poster
Average Poster

Joined: Sun Mar 13, 2016 8:50 pm
Posts: 27
I had a colonoscopy and doctor did not know anything about suboxone but said he did so after they gave me max amount of knock out meds I had to suffer as they expanded colon with air.I made a formal complaint and hopefully it was addressed.This was when suboxone was fairly new.
A year ago I had a bone marrow sample taken and doctor typed in tablet what to use with suboxone and it worked like a charm.
I have no idea what they gave me,except it burnt very bad as it went through veins due to it being either basic or acidic or maybe it leaked a bit out of vein.
Within seconds I was heavily intoxicated then woke up in recovery room.

So it depends on doctor's ability to do research and there are meds to put you under.

If you want to be safe so opiates work,I think fentanyl is traditionally used for putting one under and you may need 4-5 days without suboxone.Not only is suboxone long acting but at doses for addiction it builds up in plasma so it may not be out of body in three days or by half-life time of Suboxone.
When I was forced to stop suboxone I was using 4mg every other day and it still took 4-5 days for withdrawals to start.
If your doctor could write you a script for let's say a 4-5 day supply of hydro or oxycodone you could not have to perhaps suffer during the days of no suboxone,Given you do so safely.

I think taking hydrocodone or similar would be safer for sobriety,given you follow a tx plan,so that you don't do something stupid to chase away the withdrawal symptoms.
I have been precribed percocets,5mg,for severe back pain,and it did keep withdrawals at bay.Thats all they did but I was able to eat,sleep,etc...


Top
 Profile  
 
PostPosted: Sun May 28, 2017 8:37 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1544
I suspect you had propofol for the colonoscopy. It is commonly used for short procedures these days, it is NOT cross-tolerant with opioids (i.e. not impacted by buprenorphine meds), and it hurts when injected. When I was an anesthesiologist, I would add a cc of lidocaine to propofol, which took away that burning sensation when injected. Not sure why other anesthesiologists just let it hurt.

Even when opioids are discontinued, the surgeon will have to deal with a high opioid tolerance. For that reason I usually recommend that people stay on buprenorphine, and I treat post-op pain with high doses of oxycodone.


Top
 Profile  
 
PostPosted: Sun May 28, 2017 10:25 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
I had propofol for my colonoscopy and I'll never forget it. It even scared me a little to realize that must be
what death's like. I woke up (thankfully) not as if from sleep, but as from absolute nothingness.. It felt good :D to be back.

I read in the paper this morning they're giving it to terminal patients in Canada who elect to go that way. I don't understand why so many people object to allowing people what seems to me their absolute right
to die as they wish. If an individual doctor feels strongly that's not something he or she wants to provide, that's fine. But other doctors who don't feel that way should be permitted to bestow this act of ultimate mercy. Personally I think the claim that assisted suicide violate the Hippocratic oath is silly. Death in these cases is not only inevitable but near. The harm is in letting people suffer terrible deaths when they don't have to

It seems highly insane we don't give people the same kind of mercy we wouldn't think of withholding from an animal.

Sorry to sidetrack this thread. I completely sympathize with the original poster. I live in fear of needing surgery at some point and am currently doing what I can to at least get my daily dose below 4 mg. Currently
at 5 or so. Getting there slowly


Top
 Profile  
 
PostPosted: Mon May 29, 2017 4:17 pm 
Offline
Super Poster
Super Poster

Joined: Fri Jul 24, 2009 10:45 pm
Posts: 132
repthe, I hope that your surgery went well. For others worried about surgery and pain control. I had surgery while on buprenorphine. My surgery was at a large hospital and the doctors did RX adequate pain medication. I spent the first day after surgery in the ICU with dilaudid via P.C.A pump. I was so doped up it was like an out of body experience. After 24 hours I was transferred to a med-surg floor on oral medication. Did not do very well with oxycodone(wore off too quickly) so doctor changed to hydrocodone, 20 mg every 4 hours. Nurse told me that hydrocodone lasts longer than oxycodone for many people--did for me.


Top
 Profile  
 
   
PostPosted: Mon May 29, 2017 5:04 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
jeandianne wrote:
repthe, I hope that your surgery went well. For others worried about surgery and pain control. I had surgery while on buprenorphine. My surgery was at a large hospital and the doctors did RX adequate pain medication. I spent the first day after surgery in the ICU with dilaudid via P.C.A pump. I was so doped up it was like an out of body experience. After 24 hours I was transferred to a med-surg floor on oral medication. Did not do very well with oxycodone(wore off too quickly) so doctor changed to hydrocodone, 20 mg every 4 hours. Nurse told me that hydrocodone lasts longer than oxycodone for many people--did for me.



Hello jeandianne,
I hope you don't mind my asking what your daily dosage was at that time? Were you continuing with your usual bupe schedule right up until say, the day before surgery? Did you have a discussion with your surgeon or anestheiologist before hand? I'm sorry to be so nosy, but your experience seems encouraging and I'd love to get a few more details if possible.


Top
 Profile  
 
PostPosted: Tue May 30, 2017 11:35 am 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2802
Location: Southwest
Godfrey,

I understand your fear of needing surgery in the future while being on Buprenorphine. But coming from one who's been through it, no need to stress out my friend. Consider yourself lucky to be a large part of this forum with the backing of a very good physician. With his papers written and all the other information available here I do not fear another surgery at all. Yes, I am down to 2 mg's per day and you'll get there too in time. My dose was actually lower but I got tired of constantly trying to cut them in precise pieces so I just gave up and stick with 2 mg's. Just being lazy I guess.

If and when the time comes for more surgery, which I know it will. I will be better prepared to have a good conversation with my doctor regarding pain treatment. No way in hades am I going to go through what I did the last time. My wife still thinks I should sue after all these years when we talk about it. She's madder than me! But then, being the caretaker of me, it was very hard on her. Meaning, I do all the work around here. Shop, cook, clean, run all the errands, and still drive her to and from work. Yes, she does a lot too but I like to cook and am retired. She ended up going back to work full time to help us pay the medical bills and did all the stuff I normally do so of course she was pissed. But it was mostly seeing me in pain. Not her having to do more work.

Okay, enough of me. How is our OP doing? He/she hasn't checked in for an update yet. We all hope your surgery went well and your pain was treated properly.

rule

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 11 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

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

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

Powered by phpBB® Forum Software © phpBB Group