Hi, everybody:

I use two narcotic painkillers to control the severe chronic pain caused by my generalized internal chronic RSD:
-Duragesic (fentanyl) 125 mcg: one 100 mcg patch and one 25 mcg patch every 72 hours
-MSIR (morphine sulfate immediate release) 30 mg: one capsule once or twice daily

When I have general anesthesia for my knee surgery, I would like to know if my high tolerance for narcotics can cause the anesthesia to be ineffective, with me waking up during the surgery without anyone knowing about it and, worse, with me being in severe pain from the surgery but unable to say anything or move.

I do not want the anesthesiologist to make me stop the narcotic painkillers before surgery. For one of the seven knee surgeries I had in the past, an anesthesiologist made me stop my Duragesic before surgery by removing the 100 mcg patch himself (he forgot the 25 mcg patch). Afterwards, it was pure hell with my RSD and its pain and, of course, the nurse refused to call any doctor because she did not believe me. All the nurse would consent to give me was some Tylenol!!! Mentioning this to the anesthesiologist I see during the pre-op anesthesiologist consultation would not do any good because I could get and usually get another anesthesiologist during surgery.

I really, really feel like cancelling the surgery because I feel scared out of my shoes.

Thanks for your information.

Using pre-operative pain medications would not make you wake up during the surgery but Duragesic will block the effects of most other pain killers that you might need during and after surgery. This includes all opiates which are most commonly prescribed to manage post operative pain. That is the reason the patch is usually stopped pre-op, but the Fentanyl would probably be continued as it doesn't do the same thing.

May I suggest you ask our resident pharmacy expert, mrsD? I'm sure she'll be able to answer better than I can.

I don't know much about anesthesia. But I do know that certain drugs may depress breathing and opiates are one class that do this. Depending on the anesthetic chosen, the doctor may have to change medications that might be additive in this regard.

On the other hand putting you into withdrawal seems medically stupid and risky. You need to ask the right questions to get the answers you need.

When I had my Rectocele surgery, I made sure my Pain Specialist (who is with the same hospital) was to take care of my medication after surgery. Of course, the operating doctor had to be made aware of the other doctor getting involved, as well as the hospital. This time; I did not have any withdrawal problems. It was not the anesthesia during the surgery that was the problem. It's being given the normal dose of after surgery pain med that is not sufficient for a person that has alreday become dependent on much higher narcotics.


My previous surgery (two years prior) was a nightmare because of given the normal medication afterwards. It was not enough and I went into horrible withdrawal. Luckily, my son & daughter got the hospital to contact the Pain Specialist and he upped my meds and everything was under control. I never want to go thru that again. It is understandable about being frightened having surgery.

Again, there was not any problem, either time with the anesthesia during surgery only afterwards not being given a higher dose to compensate for the narcotics that you have already become dependent upon and the pain meds for the surgery itself.

Hi ~ I'm one of those who require more than "normal" dosages of pain meds, plus I often wake up during surgery. I've been like this since I was a child. I guess I take after my Dad.

When I'm going to have surgery, I ALWAYS talk to the anesthesiologist who will be attending me, so I can explain how I wake up during surgery. I've NEVER had one ask me to discontinue my pain meds -- that's cruel! The anesthesiologists have told me that waking up during surgery isn't that RARE. They have said that it happens often. I must say that it's frightening -- I was having spinal surgery so I was on my stomach with my head buried in a "face pillow." I couldn't tell anyone I was awake cause I'd been given the drug to keep you from moving! LOL Finally, someone saw that I was awake -- I didn't feel any pain, but it was just scary.

Don't cancel your surgery -- just ask to speak to the anesthesiologist that YOU will be having the morning of your surgery. Best of luck. Hugs, Lee

Hi, koala77:

Quote: "Duragesic will block the effects of most other pain killers that you might need during and after surgery. This includes all opiates which are most commonly prescribed to manage post operative pain."

When I had femoral nerve blocks to control my post-operative knee pain, I sure felt that these blocks were practically totally ineffective against the pain. I now wonder if Duragesic played a role in this.

Maybe the anesthesiologists could have avoided this if they had given me (in the femoral nerve blocks, in an IV line, or orally) a narcotic painkiller from the same family as fentanyl (Duragesic), which is an opiate agonist. Feel free to correct me if I am wrong.

Quote: "That is the reason the patch is usually stopped pre-op, but the Fentanyl would probably be continued as it doesn't do the same thing."

There is something I do not understand in this statement. You state the reason why the patch(es) would be stopped pre-operatively, but then you mention the fentanyl "would probably be continued as it doesn't do the same thing." The patch is made of fentanyl; this is what I do not understand.

Quote: "May I suggest you ask our resident pharmacy expert, mrsD? I'm sure she'll be able to answer better than I can."

I sure will read mrsD's answer when she replies. Thanks for your information.

Hi, mrsD:

Quote: "Depending on the anesthetic chosen, the doctor may have to change medications that might be additive in this regard."

This could be the main reason why the anesthesiologists tried, for almost each of my seven left knee surgeries, to convince me to accept regional anesthesia. I told them I would never, ever accept that kind of anesthesia, even if my life depended on it, because I absolutely refuse to be awake during surgery to hear surgeon's comments and feel probing, cutting, etc. even if these are not painful. It is psychological, not physical. The anxiety pills I was given pre-operatively have never made me feel sleepy or unaware of anything going on around me. I guess the dosage was much too small.

If I was on the operating table, awake and scared out of my mind, I might very well try to remove the operated-on knee as a defense reflex, even if it is dangerous while the surgeon is working on the knee. I know the anesthesiologists inject something to immobilize the operated-on leg's muscles, but this medication will not immobilize the whole body, so with my arms, I could push my operated-on leg "out of the way" out of fear and pain. One of my friends tried this and got her head bitten off, so she threw a tantrum like a child, screaming and crying. Then she asked me to find her a malpractice lawyer, which I did. She wanted to complain about the anti-anxiety pill being totally ineffective (just like in my case) and the fear and psychological pain it caused her. I think the lawsuit is still going on.

Quote: "On the other hand putting you into withdrawal seems medically stupid and risky."

I agree with you. It could cause stress which would, in turn, cause panic attacks, then asthma and epilepsy attacks. In the past, I already had asthma and epilepsy attacks.

Quote: "You need to ask the right questions to get the answers you need."

I really want to be put out in my hospital room, even if I have to sign a discharge for the anesthesiologists and hospital. The sight of the operating room and all the machines in it would scare the hell out of me even before the anesthesiologists have enough time to completely put me out.

The last time I had surgery (my seventh knee surgery), I was in my hospital room when a nurse came in to put a mask on my face. I do not know what medication went inside my body through the mask. The nurse never even opened her mouth to say anything. The next thing I remember is waking up in my hospital room after the operation. I do not remember anything that happened between the time the mask was put on my face before the surgery and the time I woke up in my hospital room bed after the surgery. If I was really put out in my hospital room, I can only thank the anesthesiologist with all my heart, especially for not telling me he was going to put me out in the hospital room, so I did not have time to even be scared.

I will have to find an anesthesiologist who can do general anesthesia with my fentanyl patches. On the anesthesia consent form, I will write that I refuse that my fentanyl patches be removed for security and personal reasons.

Thanks for your information.

Hi, ger715:

Quote: "When I had my Rectocele surgery, I made sure my Pain Specialist (who is with the same hospital) was to take care of my medication after surgery."

Unfortunately, there is no qualified pain management specialist in my area. My primary care physician takes care of my chronic pain management, but I am not sure at all that he would accept to take care of my post-operative pain management. Whenever the hospital's nurses see me with the morphine capsules prescribed by my primary care physician for my RSD breakthrough pain control, they either call the shrink or seize my medications. The next time, I will call the cops for theft.

I will remember for the rest of my life what one of the young female nurses did to me. One time, I was in sooo much pain in my bed (I was crying and writhing on my bed, with my two-year-old baby boy looking at me wide eyed) that I called a nurse to help me by pressing on the button. Of course, it was that young female nurse that came. She bit my head off first and then she treated me as if my pain was in my mind. When she left, I left my bed with my walker and IV pole and bags to go to the ER one level below (I took the elevators). I asked for help there. Then guess what?!?! That same young female nurse came down and dragged me back to my hospital room. Then she called the shrink (as if my pain was in my mind). I must admit I felt a LOT of pleasure when I kicked the shrink out of my hospital room. I will also admit I HATE shrinks! I was in sooo much pain that I was getting ready to AWOL.

Quote: "It's being given the normal dose of after surgery pain med that is not sufficient for a person that has already become dependent on much higher narcotics."

This is one of the things I am worried about. Even if the anesthesiologists know what dosage of narcotic painkillers we take, it seems like we will not receive a dosage adapted to our tolerance for narcotics. Of course, not all anesthesiologists are like that, but a lot are.

I am glad you got the pain relief you deserve through the help of your son and daughter. Unfortunately, my son, who is only two-years old, cannot do anything for me. My parents treat me like a druggie, so no help to hope for from that side. I guess I will just have to hide some narcotic painkillers (fentanyl patches and MSIR capsules) in a locked box hidden under my pillow, which I would take with me to the bathroom when I have to pee.

This surgery is really a NIGHTMARE! It is starting to give me a big headache again! Last night, at home, I woke up screaming after the same nightmare: seeing blood splattered on the floor, walls, and ceiling of the operating room. What is that nightmare supposed to mean? Fear! Fear! Fear!

Thanks for your information.

Hi, Leesa:

You often wake up during surgery!!! How did you handle that? What did the anesthesiologist and surgeon do?

Quote: "When I'm going to have surgery, I ALWAYS talk to the anesthesiologist who will be attending me, so I can explain how I wake up during surgery."

How can you know the anesthesiologist you talk to before surgery will be the same who will take care of you during surgery? In my area, the anesthesiologist I talk to before surgery is usually a different anesthesiologist than the one who takes care of me during surgery.

Quote: "I've NEVER had one ask me to discontinue my pain meds -- that's cruel!"

I totally agree with you, but the anesthesioplogist did not give me a choice. All I could expect after surgery was pain. The next time, I will hide some fentanyl patches and morphine capsules in a locked box in my room. Aaah! If I could get some fentanyl lollypops! They are the best for me for post-operative pain control. I guess this is why fentanyl patches also work so well for me.

Quote: "The anesthesiologists have told me that waking up during surgery isn't that RARE. They have said that it happens often."

I do not know how I would react if anesthesiologists told me the same thing. It takes a lot of guts to keep one's calm while hearing this!

Quote: "I couldn't tell anyone I was awake cause I'd been given the drug to keep you from moving!"

To say that this is horrible would be an understatement. I guess you had general anesthesia with this immobilizing drug, not simply regional anesthesia.

Quote: "Finally, someone saw that I was awake -- I didn't feel any pain, but it was just scary."

How did they find out you were awake and what did they do to help you afterwards?

Thanks for your information and kind words.