Question re: stopping Fent patch for Surgery reasons - Pain Management Message Board

katlin09 · 08-08-2008, 10:27 AM

Okay I'm on Fentanyl 50mcg/48hrs for about 4 months, I started on 25 mcg about 9 months ago. Never really felt any real "change" or "effects" when I started the patch, nor when I uppped it. It controls my pain somewhat, but still at a 6 or more at times. The things is I am fixing to have a tibia realignment surgery on my left knee in September and need to ween off the Fent patch for better pain control post surgery. I need to do this over a period of 3 - 3 1/2 weeks. I don't think this will be a big deal because I never really feel any reaction to the patch, I've actually forgotten to put on on for a couple of days, and it's been no big deal. I also take 10 other meds, so I don't know if this is why or not. So my question is does anyone have any input about this. I am seeing my PM doc on Monday for his input, but plan to start backing off today by only uncovering part of the patch when I change them out. I also use Mylan patches, so this may be why I don't se any reaction to them as well.

forginon · 08-08-2008, 12:10 PM

IMHO, you should not have to stop the patch in order to get adequate post-op pain control.

You s/b able to continue the patch and be given something additional through IV. This is a no-brainer, and I hope your PM doc will work with you on this.

I had bowel obstruction surgery when I was on 175mcg/hour Duragesic patches and all they did was add fentanyl IV to cover the post-op pain. During the hospital stay, as the pain subsided they titrated the fentanyl IV downward until I was able to leave the hospital using the same amount I went in with.

Many times folks think they are getting no relief from an opioid med, and try to stop - only to learn they really were getting relief, just not enough. And, because of the tolerance developed, they suffer withdrawals too. Even though you have gone a a couple of days w/o changing a patch, that doesn't mean you will be WD free. Hopefully your PM doc will see through the nonsense about having to stop the patch and speak with your surgeon about pain control post-op. You might ask your PM to manage your post-op pain - that's what I did with my surgery.

steve

steve

forginon · 08-08-2008, 02:36 PM

Sounds tough.

A few years ago I had a high tibial osteotomy with an external fixator. The end result is to create a gap between the femur and the tibia to account for the lost meniscus which acts as a buffer between the upper and lower leg bones. This is to keep from being bone on bone. So they break the tibia at about two-thirds of the way up towards the knee, then they cut a pie shaped piece of bone out of the tibia above the break. Then they use three large screws and attach an external bar the length of the tibia. The bar is collapsable, and each day you tighten a screw about a quarter turn 3 times per day. This causes the tibia to change the angle at which it faces the femur creating this gap. I was supposed to be in just overnight, but the pain and the fever that developed kept me in another day or two. About two weeks into the daily adjustments I developed staff and gangrene at the base of the screws, in the bone where the screws were embedded. I returned to the hospital for a "debridement" where they essentially scraped out the staff and gangrene. I've never had such pain in all my life.

During all this I was kept on my normal LA opioid, and they just augmented it with IV morphine to control pain. They sent me home with dilaudid for post-op pain. Now they want to do the same procedure on my right leg and it'll be a cold day in you know where before they ever get close to my knee again.
I wish you the best of luck.

steve

katlin09 · 08-08-2008, 03:28 PM

Steve,

Yeah I'm hoping this goes well because when my left knee heals I have the right to look forward to. But hey thanks for scaring the crap out of me! But back to my first question, do you think I'll be able to wean it down in 3 to 3 1/2 weeks or is that totally unreasonable?

Thanks,

Kat

Administrator · 08-09-2008, 08:31 PM

Do not use the boards to figure out how to self-medicate. Doing so will result in loss of board use.

You may ask opinions about meds, but not how to raise or lower doses.