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HELP!!!!! I’m so confused. I am having surgery on Friday and have been told to stop suboxone (8mg twice a day) 24hrs prior. I’ve taken it for a little over 2 years and it has really changed my life-for the good. Now I’m scared after reading everything. I do not want it to interfere with anesthesia. Post op I had planned to go back on suboxone. The surgeon is implanting a pump that delivers xylocaine directly to the site of the surgery so I feel certain that will be a tremendous help I just don’t want to “wake up”while under general anesthesia(I’ve heard horror stories about that happening).
Someone please reply ASAP now I can’t sleep!
Thanks so much for reading this
Carrie, I am a Board Certified Anesthesiologist (I took the Boards back when they lasted for life! good for me!). It would take an idiot anesthesiologist for Suboxone to interfere with the anesthetic. Suboxone (buprenorphine) blocks only the narcotic–nothing else. During surgery there are different ways to give an anesthetic, but the ‘amnesia’ does NOT rely on opiates. In fact, it is possible to provide deep anesthesia with no opiates at all, using only the ‘inhaled’ anesthetics (that does NOT mean that YOU inhale them while awake– you are put ‘out’ using propofol, which is NOT blocked by Suboxone, and then a gas is given through the endotracheal tube or mask after you are unconscious).
Anesthesia can also be provided using a propofol infusion– again, not blocked in any way by Suboxone. It is possible to do a ‘narcotic-based anesthetic’, but in that case the amnesia usually comes from a low amount of gas, or a benzo, or some propofol– none of which are blocked by Suboxone. Let the anesthesiologist know you are on buprenorphine, and if he looks confused tell him it is ‘a partial agonist at the mu receptor’ and he will undertand! If he acts like you are causing him a tough day, he is only being a jerk– because Suboxone is NOT a problem.
There IS an issue is post-op, because that is when you need a narcotic– for pain control. Here is what I usually recommend for patients who have surgery: if you are on 16 mg of Suboxone per day, try to stop it two or three days before the surgery– that way there will be less block in the recovery room when they give you narcotic for pain. If you are on a lower daily dose– like 4-8 mg– stop the day before the surgery. In both cases you will still be partially blocked, but if they give enough narcotic you will be fine.
I cannot act as your doctor, so be sure to communicate this issue with your own physician. If it helps, you can share my approach. I tell patients to skip Suboxone the morning of surgery. There is no need for it– the withdrawal takes 2-3 days to come on, and you are better off without the extra blockade. If you are having trouble with pain after the surgery, they should put you in the ICU, and prescribe however much narcotic it takes. The reason for the ICU is because many nurses just won’t be comfortable giving large doses of narcotic on the regular unit.
Again, Suboxone will NOT cause a person to ‘wake up’ during anesthesia– if that happens it is not from the Suboxone, it is from something else entirely. If it happens call me so I can help you get a big malpractice judgment! And afterward, tell the nurses to call your Suboxone prescriber if necessary to make sure they give you enough pain medication– I often have to get involved to comfort everyone and hold their hands so they feel safe giving the large doses that are sometimes required.