I?m having oral surgery on Friday morning. I?m getting 4 wisdom teeth removed (2 impacted) and one severely damaged tooth removed. They will be using general anesthesia that the drug combo includes Fentanyl. I?m being put completely out, not Twilight. The oral surgeon suggested I consult with my Sub doc regarding sub use prior to surgery because most sub docs recommend to stop using it a few days prior to surgery so there is no drug interaction with the anesthesia. When I discussed this with my sub doc, he really had NO IDEA. He read about drug interactions in a book and searched on Google, and then said I should be fine, but he suggested I try to lower my dose or stop taking it a few days before surgery if I could. He said in the worst case scenario I?ll OD, but they?ll bring me back because they want to get paid... not funny. He wrote a note to the dentist saying to protect my airway and that I may need higher doses of Fetanyl due to tolerance. But in general he?s very unhelpful and unprofessional. I have severe dental and health anxiety and have avoided this procedure for years because of it. So I decided to stop taking Sub a few days before surgery and switch to Oxy, and of course to be 100% honest with the oral surgeon about what I?ve been taking. Should I be concerned? Any advice? A little background... I?ve been on either pills, Sub, or methadone for the last 12 years. I?ve been taking 8mg sub daily for the last year. 36 hours prior to surgery, I?ve switched to 40mg oxycodone split into 4 daily doses. I?m scared I?ll wake up during surgery or I?ll OD. Has anyone gone through anything like this? Also, can I take 10mg Oxy the morning of surgery so I?m not sick and more anxious? I know I?m over anxious, but I really don?t want to delay the surgery any further, and could use all the advice I can get. Thanks so much for reading!
-
BDD Moderators: Keif’ Richards | negrogesic
Switching from Sub to Oxy before Oral Surgery, please help!
- Thread starter FeatherB
- Start date
Pickledlemons
Bluelighter
- Joined
- Oct 4, 2017
- Messages
- 2,012
I have been into multiple surgeries while on suboxone and they gave me fentanyl, it worked just fine and I didnt feel any pain. For my second surgery I asked for more fent just because it felt good, the dr gave it to me and still no issues. Fent is one of the only opioids that will cut through suboxone. I would have just stayed on sub.
Welcome, FeatherB! I have had oral surgery while taking Suboxone. They called what I had "twilight sleep", but I was put completely out with Propofol. I am not sure if the name really matters, but this oral surgeon said it was "twilight sleep" because I would not be so deep under that I would need a breathing machine or an anesthesiologist to monitor. While that really is neither here nor there, I guess the point is that I was put under the same level of anesthesia. Because I needed to report back to my Suboxone doctor and would need to be drug tested, I got a listing of all the meds that were used. They were: Fentanyl, Propofol and Midazolam (a benzo often given through IV to prep for anesthesia). Probably a couple of others but these were the pertinent drugs used. So it sounds like we are right in the same ballpark. (EDIT: Okay I still had the paper! Woo! They were: Propofol, Fentanyl, Versed (Midazolam), Dexamathesone and Zofran).
It is important to note that the opioid blocking effects of Suboxone (Buprenorphine) last much longer than just a few days. Some people have reported experiencing an intense dampening effect of opioids for up to a month after stopping. However, provided your oral surgeon is aware of this it should be fine. You may need to make them aware of this since a lot of oral surgeons have not dealt with Suboxone patients before. I had my oral surgery and went out like a light before he took his thumb off the plunger of that Propofol. Really, the Fentanyl and even the Midazolam are a small part of the anesthesia when compared to the power of Propofol. You should not wake up during the procedure or anything like that but one of the reasons why they use twilight sleep during oral surgery is because the risks even if a patient does start to come-to during the procedure are much lower compared to other types of surgery. They used to do this procedure with patients fully awake and aware just a couple of decades ago.
I will say I would not even bother taking any opioid pain meds if they have offered them to you for your switch away from Suboxone and for recovery. Of course that is a decision for your doctor and surgeon, but they will essentially do nothing for you because the opioids are going to be mostly blocked. You will likely quickly move back to using Suboxone after your procedure and then you will have a mostly full bottle of narcotics hanging around that could end up doing nothing but causing problems down the road.
So in short, talk to your oral surgeon and let them know that opioids are likely mostly blocked in your system and will be for the foreseeable future. They may consult with their colleagues and will hopefully come to the conclusion mine did that it is safe to proceed. I never stopped taking my Suboxone and even took it the day before the procedure. The chances of you ODing off of the dentist-setting doses of Fentanyl that they will be giving are almost non-existent if you have been on Suboxone for more than a month. I would be more surprised if you felt anything from it, actually. The chances of you waking up are slim-to-none but even if you did have a couple of foggy memories, that is all they would be. Hopefully your Suboxone-prescribing doctor gave you a full prescription so you can go back to taking your Suboxone after your procedure. Although I had a different procedure, we will likely in about the same shape leaving. I had 4 teeth pulled including one that was broken off at the gum line and had a bone graft to begin prepping for implants. I was able to take my Suboxone as soon as the local anesthetic wore off and I regained control of my tongue. Your regular dose of Suboxone (or perhaps no more than about 15 - 20% larger dose) will give you the best pain relief that you will be able to get off of any medication.
Of course you should take all of this with a grain of salt as I am not a doctor but only speaking of my own anecdotal experience. Be honest with your doctors and listen to their advice. Best of luck and I hope you are able to have your procedure soon!
It is important to note that the opioid blocking effects of Suboxone (Buprenorphine) last much longer than just a few days. Some people have reported experiencing an intense dampening effect of opioids for up to a month after stopping. However, provided your oral surgeon is aware of this it should be fine. You may need to make them aware of this since a lot of oral surgeons have not dealt with Suboxone patients before. I had my oral surgery and went out like a light before he took his thumb off the plunger of that Propofol. Really, the Fentanyl and even the Midazolam are a small part of the anesthesia when compared to the power of Propofol. You should not wake up during the procedure or anything like that but one of the reasons why they use twilight sleep during oral surgery is because the risks even if a patient does start to come-to during the procedure are much lower compared to other types of surgery. They used to do this procedure with patients fully awake and aware just a couple of decades ago.
I will say I would not even bother taking any opioid pain meds if they have offered them to you for your switch away from Suboxone and for recovery. Of course that is a decision for your doctor and surgeon, but they will essentially do nothing for you because the opioids are going to be mostly blocked. You will likely quickly move back to using Suboxone after your procedure and then you will have a mostly full bottle of narcotics hanging around that could end up doing nothing but causing problems down the road.
So in short, talk to your oral surgeon and let them know that opioids are likely mostly blocked in your system and will be for the foreseeable future. They may consult with their colleagues and will hopefully come to the conclusion mine did that it is safe to proceed. I never stopped taking my Suboxone and even took it the day before the procedure. The chances of you ODing off of the dentist-setting doses of Fentanyl that they will be giving are almost non-existent if you have been on Suboxone for more than a month. I would be more surprised if you felt anything from it, actually. The chances of you waking up are slim-to-none but even if you did have a couple of foggy memories, that is all they would be. Hopefully your Suboxone-prescribing doctor gave you a full prescription so you can go back to taking your Suboxone after your procedure. Although I had a different procedure, we will likely in about the same shape leaving. I had 4 teeth pulled including one that was broken off at the gum line and had a bone graft to begin prepping for implants. I was able to take my Suboxone as soon as the local anesthetic wore off and I regained control of my tongue. Your regular dose of Suboxone (or perhaps no more than about 15 - 20% larger dose) will give you the best pain relief that you will be able to get off of any medication.
Of course you should take all of this with a grain of salt as I am not a doctor but only speaking of my own anecdotal experience. Be honest with your doctors and listen to their advice. Best of luck and I hope you are able to have your procedure soon!
Pickledlemons
Bluelighter
- Joined
- Oct 4, 2017
- Messages
- 2,012
Ah yes, I was given Propofol along with fentanyl as well! I just couldn't remember the name. Yeah it puts you out instantly.