Anesthesia and Suboxone, revisited…

Important enough to move to the front page:

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

Reply:

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.

J

2 thoughts on “Anesthesia and Suboxone, revisited…”

  1. Just to let you know and anyone else who may have the questions about surgery and suboxone. I had my surgery on Friday-adominal surgery and some additional procedures for vanity reasons)LOL- came home with JP drains, marcaine pump to the incision(hipbone to hipbone), scd’s etc! I have not had to take any narcotices other than the suboxone that I normally take-8mg twice/day. While in preop they did convince me to allow fentanyl intraoperatively and I reluctantly agreed. I have absolutely no recollection of the surgery and a vague memory of the recovery room. I started the suboxone back that same day(missed the am dose though)No problemsor signs whdrawal. It definately wasn’t easy but good ole tylenol, along with ice and the marcaine pump worked as good as any narcotic but without the “high”Which isn’t the purpose of opiates anyway. I’m sure the marcaine pump made a big difference.
    I’m not going to say it was easy-there were times I was praying to take the pain away, reciting the serenity prayer, etc. If anyone can learn from my experience-save yourself some agony and let you surgeon know-you’d be surprised at how they react-i had nothing but a positive experience from the entire staff-but I didn’t tell them until the day of surgery because I was embarrassed. So for two week prior to the surgery-I obessed over it, got depressed over, beat myself up over it-all for nothing! so do youself a favor and tell them in advance-just to save you some misery!
    Carrie

  2. Why did you say tell them in advance to save you some misery? What about if you just take one table of suboxen a day, do you think I need to tell them when I have the surgery?

    Thanks,

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