- Narcotics typically given in an emergency department setting do not work if you are on Suboxone, even if they are administered intravenously.
- Advise your physician you are on Suboxone. Fentanyl, a powerful narcotic, can be given while you are on Suboxone and will be effective
Procedure for Same-Day Surgery
Emergency surgery leaves no time to completely taper off of buprenorphine; even if stopped abruptly, about 2 to 3 days would still be needed to entirely clear the drug from the patient’s body.
In this case, providers have 3 main options, depending on the anticipated level of pain:
- If they deem that the surgery will only cause mild to moderate acute pain, they may continue buprenorphine, while adding and optimizing non-opioid pain modalities.
- If the providers anticipate that surgery will cause moderate pain, they can treat the patient with intravenous buprenorphine.
- If they anticipate severe pain, providers can discontinue buprenorphine in lieu of high-dose and carefully titrated short-acting opioids until the buprenorphine is cleared from the patient’s body. Hydromorphone (Dilaudid) or fentanyl is the best option for managing severe postsurgical pain under these circumstances; however, there are no standard conversion or dosage recommendations that have been studied or that can be considered a standard of care. Optimizing nonopioid analgesics, including nerve blocks, also plays an important role in all of these scenarios.