Suboxone

[N2b8]

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What is your experience taking care of patients on Suboxone? I'm presenting this Saturday on ob patients on this drug, and would like to hear your experiences in treating post-op pain. They take massive doses of full agonists, and want to hear from you on just how much you've had to give (ob or otherwise).

Thanks tons!

 

[proman]

Just use ketamine.

 

[lushmd]

Ideally, their prescribing physician has transitioned them off suboxone to opioid agonists during the week or so preceding surgery. Unfortunately, this often doesn't occur (especially in OB). I agree with proman that non-opioid analgesics work well in this situation.

 

[jrf331]

Had a similiar dilemma last year while rotating on Acute Pain. 40 yo s/p lumbar harware removal that was on suboxone and not transitioned to full agonist prior to surgery. It was a pain in the ass to control his pain post. op. Basically an ICU admission for pain to get a **** load of hydromorphone, methadone, oxycontin and ketamine. Not a fun time

My recs. Stop at least 7 days prior to surgery and have the prescribing doc transition to full agonist during that time period. That is currently our department policy.

 

[Licoricestick]

Not a problem with everyone, we've had quite a few that have just needed to be treated as opioid tolerant - continue their buprenorphine (use PCA background equivalent if NBM), use non opioid adjuvants esp ketamine, add additional opioid by PCA. Their opioid requirements generally do not exceed what we'd expect for their opioid tolerance.