Background: Perioperative use of opioids is common in surgical practice and frequently results in troublesome opioid-related side effects that often lead to suboptimal postsurgical outcomes. As such, multiple studies have sought to identify alternatives that may reduce reliance on opioid-based perioperative pain management. Recently, it has been shown that patient education and patient involvement in care positively impact surgical outcomes. This study evaluates how patient education regarding the role of endogenous beta-endorphins in reducing pain and the opposing effect of opioid analgesics impacts opioid consumption and mood after surgery. Methods: Patients scheduled for breast augmentation were divided into two groups, A and B. Both groups received identical multimodal anesthesia regimens; however, only patients in group B were educated on the role of endogenous beta-endorphins in pain control and mood enhancement, and how opioids block their action. Results: Patients in the group receiving preoperative education on the analgesic and mood-enhancing role of endogenous beta-endorphins and how opioids block their action consumed significantly less opioids and had better postsurgical outcomes as determined by self-reported measures of pain level and mood/sense of well-being. Conclusions: The findings of this study suggest that opioid use was significantly reduced and patients’ mood/sense of well-being was significantly enhanced when patients received preoperative education on the oppositional relationship between beta-endorphins and opioids. Such patient education may be linked to a significant reduction in opioid use and improved patient mood/sense of well-being, especially when combined with opioid-free multimodal anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Teleosts inhabiting fresh water depend upon ion-absorptive ionocytes to counteract diffusive ion losses to the external environment. A Clc Cl− channel family member, Clc-2c, was identified as a conduit for basolateral Cl− transport by Na+/Cl− cotransporter 2 (Ncc2)-expressing ionocytes in stenohaline zebrafish (Danio rerio). It is unresolved whether Clc-2c/clc-2c is expressed in euryhaline species and how extrinsic and/or intrinsic factors modulate branchial clc-2c mRNA. Here, we investigated whether environmental salinity, prolactin (Prl) and osmotic conditions modulate clc-2c expression in euryhaline Mozambique tilapia (Oreochromis mossambicus). Branchial clc-2c and ncc2 mRNAs were enhanced in tilapia transferred from seawater to fresh water, whereas both mRNAs were attenuated upon transfer from fresh water to seawater. Next, we injected hypophysectomized tilapia with ovine prolactin (oPrl) and observed a marked increase in clc-2c from saline-injected controls. To determine whether Prl regulates clc-2c in a gill-autonomous fashion, we incubated gill filaments in the presence of homologous tilapia Prls (tPrl177 and tPrl188). By 24 h, tPrl188 stimulated clc-2c expression ~5-fold from controls. Lastly, filaments incubated in media ranging from 280 to 450 mOsm/kg for 3 and 6 h revealed that extracellular osmolality exerts a local effect on clc-2c expression; clc-2c was diminished by hyperosmotic conditions (450 mOsm/kg) compared with isosmotic controls (330 mOsm/kg). Our collective results suggest that hormonal and osmotic control of branchial clc-2c contributes to the freshwater adaptability of Mozambique tilapia. Moreover, we identify for the first time a regulatory link between Prl and a Clc Cl− channel in a vertebrate.

The Mozambique tilapia, Oreochromis mossambicus, is a teleost fish native to estuarine waters that vary in salinity between fresh water (FW) and seawater (SW). The neuroendocrine system plays a key role in salinity acclimation by directing ion uptake and extrusion in osmoregulatory tissues such as gill. While most studies with O. mossambicus have focused on acclimation to steady-state salinities, less is known about the ability of adult fish to acclimate to dynamically-changing salinities. Plasma osmolality, prolactin (PRL) levels, and branchial gene expression of PRL receptors (PRLR1 and PRLR2), Na+/Cl− and Na+/K+/2Cl− co-transporters (NCC and NKCC), Na+/K+-ATPase (NKAα1a and NKAα1b), cystic fibrosis transmembrane conductance regulator (CFTR), and aquaporin 3 (AQP3) were measured in fish reared in FW and SW steady-state salinities, in a tidal regimen (TR) where salinities changed between FW and SW every 6 h, and in fish transferred from FW or SW to TR. Regardless of rearing regimen, plasma osmolality was higher in fish in SW than in FW fish, while plasma PRL was lower in fish in SW. Furthermore, branchial gene expression of effectors of ion transport in TR fish showed greater similarity to those in steady-state SW fish than in FW fish. By 7 days of transfer from steady-state FW or SW to TR, plasma osmolality, plasma PRL and branchial expression of effectors of ion transport were similar to those of fish reared in TR since larval stages. These findings demonstrate the ability of adult tilapia reared in steady-state salinities to successfully acclimate to dynamically-changing salinities. Moreover, the present findings suggest that early exposure to salinity changes does not significantly improve survivability in future challenges to dynamically-changing salinities.

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