'A Patient Voice' Community

You should tell your surgeon what you are taking, they should be able to advise you. Take care, and good luck with your surgery!

hello, A --

because you are taking suboxone/buprenorphine-naloxone (see PS1), you are more opioid-tolerant than people who are not taking it. this means that you need more and/or different meds for anesthesia and postoperative pain relief than would be appropriate for others in order for it to be effective.

in my admittedly quickie internet research on your inquiry (PS2), i have seen advice both to stop suboxone a few days before surgery and not to stop it a few days before surgery (PS3). whether or not you stop your suboxone before surgery, you absolutely must inform your anesthesiologist in advance -- and preferably your surgeon as well -- that you have been taking this med, at what dosage, and why (PS4). this info will help the anesthesiologist decide how to modify or supplement the anesthetic agents you need, because standard opioid-based anesthetic techniques will be insufficient.

ideally, your suboxone-prescribing dr, your surgeon, and your anesthesiologist should talk with each other before your surgery to make sure that everyone is on the same sheet of music, so to speak. you must also make sure that your postoperative/aftercare nurses and aides are aware that you are more opioid-tolerant than other patients; otherwise, they will not know what amt of pain relief meds will make a difference.

possibilities for anesthesia and pain relief could include local or regional nonopioid analgesics, preemptive celecoxib or pregabalin, preloading of incision sites with local anesthesia, use of an epidural catheter both during and after surgery, and postoperative ketoralac (PS5); others might include inhalation techniques, nerve blocks, and epidural anesthesia.

finally, your anesthesiologist or surgeon can talk with a suboxone expert from the physician clinical support system (PCSS), http://www.naabt.org/documents/pcssbrochure.pdf , http://www.pcssb.org/about/who-we-are , http://www.pcssb.org/mentors-and-mentees/mentee , of the substance abuse and mental health services administration of the u.s. dept of health and human services, for more specific advice (PS6).

i send you caring thoughts and hope your surgery goes well.

-- susie margaret

PS1 -- webMD info on suboxone/buprenorphine-naloxone is at http://www.webmd.com/drugs/mono-8352-BUPRENORPHINE%2fNALOXONE - SUBLINGUAL.aspx?drugid=64741&drugname=Suboxone SL&source=2 .

PS2 -- i am not a medical person; i welcome, solicit, and indeed beg for correction, amendment, or replacement of inaccuracies in this post.

PS3 -- stopping your suboxone may precipitate withdrawal symptoms, in which case your dr can prescribe short-acting narcotics. an example of such short-acting narcotics would be percocet 5/325, #10, one poq 4 h prn; this should postpone withdrawal for a few days, according to kunkel, F., "anesthesia alert -- pain management in patients taking suboxone," outpatient surgery, vol. 10, no. 3 (march, 2009), http://www.outpatientsurgery.net/issues/2009/03/anesthesia-alert .

PS4 -- suboxone/buprenorphine-naloxone helps prevent withdrawal symptoms consequent to stopping other opiate-type narcotics.

PS5 -- these suggestions are taken from bryson, E.O.; lipson, S.; and gevirtz, C., "anesthesia for patients on buprenorphine," anesthesiology clinics of north america, vol. 28, no. 4, pp. 611-617, 615-616 (december, 2010), http://mountsinai.academia.edu/EthanBryson/Papers/382399/Anesthesia_for_patients_on_buprenorphine .

PS6 -- an additional useful brochure is fiellin, D., "treatment of acute pain in patients receiving buprenorphine/naloxone" (november, 2005), http://www.naabt.org/documents/PCSSAcutePainGuidance.pdf .