Butrans and SCS

[bedrock]

First for me. Doing an SCS trial on patient on chronic butrans (15). I typically do my scs trials with if sedation and she has needed lots of iv sedation in past. Worked ok, but I think she’ll need more this time.

Would any of you ask the patient to remove the patch and if so for how long before the trial?

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[Agast]

I don’t make any changes before a trial, it will confound the results. Are you worried it will interfere with the sedation? Shouldn’t really. For pain relief documentation I would make her do more of the things that typically cause pain, like spend the day walking around at the mall or something.

 

[RoloTomassi]

I would leave it. How high do you go on versed?

 

[MitchLevi]

Shouldn't interfere.

 

[deleted875186]

No way I would remove it.

 

[soccrwz]

its competitive antagonism is very low with butrans patch

 

[Orin]

Agree, leave the Butrans alone. If you're worried or struggled with sedation previously for cases for her, you can try to schedule the trial for day 7 or the first day of her patch rotation.

Versed and local will have more bang for your buck than the usual fentanyl doses, but generally Butrans isn't strong enough even at the 20 mcg/h patch to mess with periprocedural stuff.

If you must remove it, 24-48h is enough to lose most of the buprenorphine out of the system based on the initial work.

Once-Weekly Transdermal Buprenorphine Application Results in Sustained and Consistent Steady-State Plasma Levels

Transdermal formulations of buprenorphine offer controlled delivery of buprenorphine for sustained analgesic efficacy with reduced adverse events (AEs) compared with the other modes of administration. A buprenorphine transdermal system (BTDS) delivering 5, 10, or 20 mcg/hour for seven days is...

www.jpsmjournal.com

 

[lobelsteve]

First for me. Doing an SCS trial on patient on chronic butrans (15). I typically do my scs trials with if sedation and she has needed lots of iv sedation in past. Worked ok, but I think she’ll need more this time.

Would any of you ask the patient to remove the patch and if so for how long before the trial?

Absolutely not.

 

[kstarm]

There is almost 0 data in this space, but I wouldn't change anything for butrans or belbucca. We don't recommend changes to suboxone until greater than 8mg and I have had push back from the addiction doc that we should have the cut-off at 12mg. This has more to do with risk of relapse. There are typically many factors that are not the bupe that leads to issues with procedural sedation in this group.

 

[deleted875186]

First for me. Doing an SCS trial on patient on chronic butrans (15). I typically do my scs trials with if sedation and she has needed lots of iv sedation in past. Worked ok, but I think she’ll need more this time.

Would any of you ask the patient to remove the patch and if so for how long before the trial?

I initially thought you were referring to stopping the Butrans for the trial, not because of the sedation.

Fentanyl will still work with low dose bupi, titration to effect, just wait a bit longer after giving sedation. How much sedation did the patient require with the last procedure?