UK - Wisdom tooth removal under GA -pain relief (whilst on methadone)

[Helene]

Okay, this is a slightly complicated situation, but I'll go ahead and try and explain it anyway.

Background: I'm on a methadone script, 100mg a day, so I suppose you could say I have a higher than usual tolerance to opiates. I'm booked in to have three impacted wisdom teeth removed on the 14 of this month. Due to the position of the teeth, and the fact that a small section of my jaw bone needs to be removed in order to access them, my dentist has told me that I should have the procedure done under a general anaesthetic, and I have been referred to hospital accordingly.

My query is this: What pre- and post- operative pain relief do they give? I've heard mention of IV doses of fentanyl, morphine etc, but think that this is mainly in the US? Do they give you a dose of painkillers in with the anaesthetic, or not? And do they give IV painkillers after the op?

I'm slightly concerned that my increased tolerance to painkillers might render them less effective, and I will be left in a lot of pain.

I've been perfectly honest with the dentist and consultant about my methadone script/ heroin use, but I still fear that any comments I make about reduced efficacy of pain relief might be construed as "drug-seeking behaviour" and thus be disregarded.

I've been told that for people on (addicted to) methadone (and other opiates), the time taken to recover from a GA is increased, and so I have been allocated a bed and admitted to the hospital over-night, following the op.

I understand that this is a fairly specialised situation, and realise how unlikely it is that someone else has experienced the same, nonetheless, I'd appreciate any information anyone could give about general pain relief prescribing practices in the UK, for wisdom tooth extraction under GA, with the complications described above, impacted teeth, jaw-bone removal etc (methadone script not-withstanding)

Any comments would be appreciated, thanks in advance,

H

 

[Gordon]

I've done lots of GA extractions for IV drug users, haven't noted any increased recovery time from the GA and haven't had to admit any of them overnight (so far, touches wood!).
Sounds like whoever is doing your extractions is being hyper cautious, which should be a bit reassuring for you.

According to all the experts out there, the best pain relief for dental extractions is non-opiates, such as ketoprophen and ibuprophen type drugs, which you won't have an increased tolerance for. If narcotics are necessary then since you're being admitted anyway, they could increase the dose to deal with your increased tolerance.

 

[Helene]

Okay, thanks for your reply, Gordon.

Yeh, the overnight thing seemed to be just a precaution, they explained that normally the procedure would be done as a "day case" but that they'd feel more comfortable allocating me a bed for an overnight stay if I should need it. So you're right, it is just an overly-cautious doc. Which is good!

Regarding the pain relief, thanks, this info has made me feel a lot better about it all. I haven't noticed any sense of prejudice towards me from my physicians in relation to this matter, thus far, so really don't have much reason to be so doubtful, I guess it's just that part of me knows that sadly these stereotypes still exist amongst some members of the medical community, although thankfully they're getting rarer and rarer.

Your reply reminded me of my other concern, which I neglected to mention in my initial post: Veins. The anaesthetist is gonna have a hell of a job trying to get a line in me, I guess they've got ways of dealing with this...? Last time I went for a blood test they gave up after a good half hour of poking around... (the nurse seemed to think that because I was an IV drug user, I was immune to pain...) I think this difficulty was due to the rather large gauge needles they use for taking blood, is this the same for anaesthesia/ drips? I know it's still possible to get a vein with a 1ml insulin syringe, but only just... I'm rather slim, and generally a petite build, (I weigh just under 7 stone and am 5 foot 2), I never really had that great veins to begin with, but after 6 years of IV opiate abuse, well, you can imagine what sort of state they're in now.

Anyway, I'm sure anaesthetists are pretty good at this sort of stuff though, aren't they? Probably worrying about nothing.

Oh and one final thing - regards to the not eating or drinking after midnight the day before GA surgery thing: This is obviously stated on all the blurb they've given me, I understand the reasons for it (empty stomach for surgery etc). But (conversely) it also states to take any medication as normal. Does this mean it okay to have my normal 100ml dose of sugar-free physeptone methadone 1mg/ml the morning before surgery? Or is this something I should phone the hospital and check?

Once again, thanks for your reply, I'd appreciate it if you were able to reply again, to my latest worries!

Thanks,

H

EDIT: Forgot to say something else: Do you think it odd that a GA is being recommended, above sedation? Especially considering the UK regs of "no GA unless absolutely necessary"? You say you've done many GA extractions in the past, would you come to a similar conclusion for my situation? Thanks.

 

[Gordon]

Cannulation can be difficult on IV users, normally the anaesthetist will induce GA using gases rather than IV, this usually pops up some veins for them to access for the rest of the procedure, it also helpfully means you'll be asleep when they're poking about

It would be best to check with the hospital regarding your methadone, the anaesthetist I work with is fine with it but it's always best to check.

No, it's not odd at all, sedation is rarely successful on IV drug users, too much tolerance to the drugs, normally GA is my first choice 90% of the time.