- Joined
- Jul 8, 2017
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Hey everyone, I thought I'd write up an account of my recent major surgery I had while on sublocade (64mg Buprenorphine injection monthly) as a lot of people are interested in what happens if they need surgery on opiate maintenance therapy.
For starters, in the case of emergency surgery I recommend carrying a card which I'm happy to distribute the version I made that you can fill your name, prescribing doctors information, dosage, and other medical details in, to have on your person in case of any accidents so that emergency medical personnel can see you take Buprenorphine. I get a carry card every month from the clinic for the injections and the strips used to come with a card but they stopped doing that, however it is very important with this medication especially. Either that, or like how in my country we have a business called the MedicAlert Foundation where you can get personalised engraved jewellery with conditions and medications written on them and you pay $100 a year for all your information to go into a 24/7 database for paramedics and doctors to access your full medical history and medication list if needed. You never want to be in a situation where you need emergency surgery and they don't know you're on Buprenorphine, so if anyone wants that card I'll look for it and see if I can upload it for public use.
I had a full laporascopic hysterectomy and was pretty apprehensive about how my pain would be managed especially being on the monthly depot as I can't even skip or reduce the dose to lower the blocking level, but my surgeon assured me, as did my addiction medicine specialist that I'd be taken care of.
Before I went to theatre the anesthesiologist met with me to discuss my pain management options and told me that he was wanting to give me both spinal fentanyl and spinal morphine prior to putting me under, which does involve a local anaesthetic into your spine then a larger injection with the medication. I agreed on that. He also said he wanted to give me ketamine, which I've actually shockingly never ever had in my life and I was fine with that, but again a bit apprehensive when he said the hallucinations can be pleasant, or terrifying, depending on what you've got locked away in your brain. However I decided on balance I'd rather not be in pain and agreed to that. The surgeon also said she would put local anaesthetic in too.
We did have a bit of a laugh about how I chose not to take my stimulant medication (armodafonil, Modafinil and dexamphetamine) that morning because i thought it would be pointless and he said he was looking forward to seeing how much it would take to put me out on that combination, and I mentioned my recent relapse on meth which he was happy about because that is also a concern for general anaesthetic as it makes people harder to put under. Thankfully it's been about 3-4 weeks since I last used and I'm doing well so he wasn't hugely concerned about that.
Went under, enjoyed the feeling like I always do when it kicks in, then woke up abruptly in recovery in a significant amount of pain. They immediately started me on high dose fentanyl (actually the maximum dose, from what I was able to understand because I did ask for more but I couldn't be given in) and a button to press every 5 min when I wanted more. It didn't make the pain go away like it did last surgery, nor did I get any really intense opiate effects from it like you'd expect from a dose that high but that plus the ketamine sent me pretty loopy and I was comfortable enough considering I'd just had internal surgery.
They kept me an extra day to wean me off the Ketamine first (Tuesday morning) then the fentanyl (Tuesday afternoon) by which time I was managing to sleep solid amounts without waking up needing to press the button, and at that stage they transitioned me just to 5mg Oxycodone.
Since being home I've taken 2 oxy and I'm not actually in much pain at all. I don't know whether the sublocade is actually doing something (it's possible) or having a third degree burn dressed and cauterised 3X per week the last 2.5 months has just skyrocketed my pain tolerance.
Either way, you can have major surgery on Buprenorphine and not have it be pure torture. I'm doing far better than I thought I would be.
For starters, in the case of emergency surgery I recommend carrying a card which I'm happy to distribute the version I made that you can fill your name, prescribing doctors information, dosage, and other medical details in, to have on your person in case of any accidents so that emergency medical personnel can see you take Buprenorphine. I get a carry card every month from the clinic for the injections and the strips used to come with a card but they stopped doing that, however it is very important with this medication especially. Either that, or like how in my country we have a business called the MedicAlert Foundation where you can get personalised engraved jewellery with conditions and medications written on them and you pay $100 a year for all your information to go into a 24/7 database for paramedics and doctors to access your full medical history and medication list if needed. You never want to be in a situation where you need emergency surgery and they don't know you're on Buprenorphine, so if anyone wants that card I'll look for it and see if I can upload it for public use.
I had a full laporascopic hysterectomy and was pretty apprehensive about how my pain would be managed especially being on the monthly depot as I can't even skip or reduce the dose to lower the blocking level, but my surgeon assured me, as did my addiction medicine specialist that I'd be taken care of.
Before I went to theatre the anesthesiologist met with me to discuss my pain management options and told me that he was wanting to give me both spinal fentanyl and spinal morphine prior to putting me under, which does involve a local anaesthetic into your spine then a larger injection with the medication. I agreed on that. He also said he wanted to give me ketamine, which I've actually shockingly never ever had in my life and I was fine with that, but again a bit apprehensive when he said the hallucinations can be pleasant, or terrifying, depending on what you've got locked away in your brain. However I decided on balance I'd rather not be in pain and agreed to that. The surgeon also said she would put local anaesthetic in too.
We did have a bit of a laugh about how I chose not to take my stimulant medication (armodafonil, Modafinil and dexamphetamine) that morning because i thought it would be pointless and he said he was looking forward to seeing how much it would take to put me out on that combination, and I mentioned my recent relapse on meth which he was happy about because that is also a concern for general anaesthetic as it makes people harder to put under. Thankfully it's been about 3-4 weeks since I last used and I'm doing well so he wasn't hugely concerned about that.
Went under, enjoyed the feeling like I always do when it kicks in, then woke up abruptly in recovery in a significant amount of pain. They immediately started me on high dose fentanyl (actually the maximum dose, from what I was able to understand because I did ask for more but I couldn't be given in) and a button to press every 5 min when I wanted more. It didn't make the pain go away like it did last surgery, nor did I get any really intense opiate effects from it like you'd expect from a dose that high but that plus the ketamine sent me pretty loopy and I was comfortable enough considering I'd just had internal surgery.
They kept me an extra day to wean me off the Ketamine first (Tuesday morning) then the fentanyl (Tuesday afternoon) by which time I was managing to sleep solid amounts without waking up needing to press the button, and at that stage they transitioned me just to 5mg Oxycodone.
Since being home I've taken 2 oxy and I'm not actually in much pain at all. I don't know whether the sublocade is actually doing something (it's possible) or having a third degree burn dressed and cauterised 3X per week the last 2.5 months has just skyrocketed my pain tolerance.
Either way, you can have major surgery on Buprenorphine and not have it be pure torture. I'm doing far better than I thought I would be.
