Bupe Surgery while on Bupe

[Eligiu]

I'm planning to have major surgery come around August or September (hopefully at the absolute latest) and I was wondering if anyone had any experience having surgery while on Bupe, either emergency or otherwise.

I know the standard protocol used to be wean off, have surgery wean on in Australia, but they've updated the medical practitioners with information stating that a bupe patient who drops to a dose below 4-6mg is not that much more difficult to manage pain wise than anyone else, so to keep continuity of replacement therapy treatment in place and avoid any withdrawal alongside the surgery pain, the suggested practice is for the patient to taper down (if necessary) to the lowest possible dose, have surgery, then taper up again as needed.

I'm on 64mg buvidal injections so obviously I'd be required to either book my surgery at the very end of the month or to be safer, taper back onto the strips that month and reduce my dose.

Has anyone had any experience with this at all? Cause honestly I cannot survive without this surgery any longer but I cannot go off buvidal injections.

 

[G_Chem]

I had surgery while on buprenorphine, I’m only on 1mg though. They put me under with ketamine combined with another drug I’m forgetting at the moment. They then prescribed me gabapentin cuz I refused actual opioids. Not cuz I didn’t want them but because of the dirty looks I might get if I did ask.

I then used benzoylmorphine (heroin analog) to manage pain for the next month, it worked very well for the pain.

These days they can use drugs other than fentanyl to put you under, it’s the after pain management that’s going to be the problem if you don’t taper down.

-GC

 

[Treyderaid]

I highly recommend that you go ahead and taper your Buprenorphine dose to your absolute minimum. Only you can know your own body well enough to figure what that dose might be but for me it's probably 1-2mg. This advice is coming from a fellow addict who has been in your shoes. I have been on Bupe on and off (mostly on) for about 5 years give or take. I'm a type 1 diabetic and I had a really scary experience that came about due to an incident where I got ketoacidosis from an insulin pump line getting kinked in my sleep and resulting in me receiving no insulin for the whole night. Then The next morning I awoke with ketoacidosis and long story short, My liver leached K+ Ions into my blood and my heart stopped...twice. I just couldn't get my blood sugar down that day and eventually an ambulance was called to pick me up and take me to the hospital, when the ambulance arrived, I was walking to the driveway to greet them and I literally blacked out and collapsed onto the ground. I was taken in an ambulance to the hospital whereI was sedated by the anesthesiologist with fentanyl, ketamine, and midazolam (or another benzodiazepine derivative) and given an IV drip of insulin. I ended up being transported in a helicopter to a specialty hospital (with the anesthesiologist on board the whole ride) where I woke up not once but twice despite his steady administration of "massive doses of fentanyl". So The anesthesiologist knew that I was on Buprenorphine and chose to (or had to) administer Fentanyl as my anesthetic. I don't know if the reason he chose to use Fentanyl was because he thought it would be the best medical choice or if he just didn't have access to other pharmacological options at the small community hospital where all of this occurred. Anyway, I almost died a couple times during this experience and If I had not been on a maintenance dose of buprenorphine at the time I'm pretty confident I would've been way easier to sedate and wouldn't have put this anesthesiologist and myself and my loved ones through such a traumatizing experience. I think If your surgical procedure is major then you should really consider cutting your dose as low as you can stand just so that the procedure will be most likely to run smoothly. A long sedation can be a complicated and dangerous procedure, I know that from experience and I wouldn't wish it on anyone else so I've bothered to share this with you as I remember it. By The Way I'm not a Dr., I'm a patient and I'm sharing my patient experience with you as a gesture of good will. You should always talk to a Dr. before making medical decisions. Best of luck to you. Sincerely-
Trey

 

[Avallejo7707]

I'm planning to have major surgery come around August or September (hopefully at the absolute latest) and I was wondering if anyone had any experience having surgery while on Bupe, either emergency or otherwise.

I know the standard protocol used to be wean off, have surgery wean on in Australia, but they've updated the medical practitioners with information stating that a bupe patient who drops to a dose below 4-6mg is not that much more difficult to manage pain wise than anyone else, so to keep continuity of replacement therapy treatment in place and avoid any withdrawal alongside the surgery pain, the suggested practice is for the patient to taper down (if necessary) to the lowest possible dose, have surgery, then taper up again as needed.

I'm on 64mg buvidal injections so obviously I'd be required to either book my surgery at the very end of the month or to be safer, taper back onto the strips that month and reduce my dose.

Has anyone had any experience with this at all? Cause honestly I cannot survive without this surgery any longer but I cannot go off buvidal injections.

I had to get on here and reply to this bc I went thru something that i wouldn't wish upon anyone.. so I was taking 24 mgs a day of sub when I went in for oral surgery. Not thinking anything about it nor did they (oral surgery team) mention the fact that my sub could potentially have a negative effect on my anesthesia.
Because of my prior drug use I had to get a pick line put in because of my veins not being easy to get. So the day of my oral surgery I go and get a pick line put in and then immediately go to the oral surgery whereas they give me the anesthesia they tell me to count down from 10 I count down and what do you know I do not go out so they checked to make sure everything was correct and It was.. So unfortunately I had to go through oral surgery with just massive amounts of numbing agents. Mind you that I had 2 impacted wisdom tooth that had to be cut out due to it being beneath the surface and also had 2 other teeth that had to be removed that were also underneath the surface One of them in pieces.
So come couple months later I had to have surgery once again To have some skin removed due to me finding out that I had a skin cancer. Which which was found out from a mole that was removed and biopsied. The biopsy came back as malignant melanoma which is skin cancer. So in order to prevent the spreading of the skin cancer they wanted to remove a larger area of skin around where the mole was and then do a skin graph. Knowing what had happened before with my suboxone basically blocking the anesthesia I knew that I had to taper down off of my suboxone basically as low as I could and in my position I in no way shape or form wanted to be awake during the removal of skin and a skin graph so what I did was I started about a month out at this time I was only taking 8 mg A-day of suboxin. So exactly a month out from my surgery date for the 1st 5 days I went down to 6 mg, then for the next 10 days I went down to 4 mg, then for the next 5 days I went down to 2 mg. The next 5 days I went down to one mg and then in order to make sure there was no suboxone in my system whatsoever I took 3/4 of a strip on day 26 and then a 1/2 a half a strip on day 27 and then the following day a quarter of a strip. That left me with 2 days prior to surgery of no suboxone at all. Which wasn't the best of feelings but at the same time I could suffer the consequences of that alot easier than having the unfortunate experience of being awake but paralyzed during surgery. So to me it was well worth it. Immediately after surgery I had One strip waiting for me and As soon as I got home I took another one being that my pain level was extremely high and basically went right back up to my 24 mg A-day dosage that i had gotten down to 8mg a day. My doctor actually allowed me to go up to 32 mg A-day being that my pain level was pretty high. I am now 4 weeks after surgery still experiencing some pain due to the surgeon Deciding last minute that instead of doing a skin graph he would just pull the 2 edges of skin together and stitch and suture instead of doing the skin graft that was originally planned . And what ended up happening was one week after the surgery a couple of the stitches ended up coming out . So I went to the ER and they basically told me that it was more likely for me to get infected if I was to get it restitched so instead they sent me home with some anti bacterial cream and Didn't even bother to fix the broken stitches that were still coming undone And instead of me being off work for 3 weeks I'm now at 4 weeks and still have a wound that is 4" long and 2 and a 1/2 inches wide All because the doctor decided to I guess go the quick route and instead of doing the skin graph he just stitched it up which obviously was to wide of a gap to be stitched and sutured being that it only took one week for the stitches to start popping out! So what do you guys think do you think I have a lawsuit on my hands I've got pictures videos and everything every single day of how it literally day-by-day opened up to to the point to where when I went back to the ER a second time they told me flat out that They could not stitch it back together because it was more likely to get infected the same BS story that they told me b4 and that I would have to wait until Monday when my Dr got back from spring break to see me at the wound center. Can anyone please if you're in the medical field explain to me how this makes any sense because even the nurses that I've known and that I've shown the pictures too said that there is no way in h*** that they would have let me leave the hospital with a gaping wound that I had. NOT EVEN BUTTERFLY STITCHES COULD HOLD THIS WOUND TOGETHER. But back to the topic at hand I highly recommend getting down to the lowest dosage possible or even down to 0 like I did only because I did not want to experience being awake during that type of surgery. Good luck to you and I hope this helps!

 

[LucidSDreamr]

I know the standard protocol used to be wean off, have surgery wean on in Australia, but they've updated the medical practitioners with information stating that a bupe patient who drops to a dose below 4-6mg is not that much more difficult to manage pain wise than anyone else,

That is utter bullshit someone with a 4 to 6 mg bupe dependency has a very heavy opioid dependency and would require way higher doses than a naive person.

Just the war on pain patients at work.

Regardless od what you do...stock up on large amounts of whatever opioid becauze the medical establishment is going to let you be in a fuck load of surgical pain that may last weeks or mo.ths and give you zero take home opioids

 

[watermellon]

That is utter bullshit someone with a 4 to 6 mg bupe dependency has a very heavy opioid dependency and would require way higher doses than a naive person.

Just the war on pain patients at work.

Regardless od what you do...stock up on large amounts of whatever opioid becauze the medical establishment is going to let you be in a fuck load of surgical pain that may last weeks or mo.ths and give you zero take home opioids

Agreed. 4-6mg is actually a very big dose that fills pretty much all your receptors. 2mg even is almost 100% saturation