Prognostic value of preoperative CCL26 serum levels in the surgical treatment of chronic rhinosinusitis.

Postoperative pain is one of the most prevalent clinical challenge following surgery, significantly impacting patient recovery and prognosis. A US study indicates that approximately 86% of surgical patients experience postoperative pain, with around 75% reporting moderate to severe discomfort both immediately after surgery and upon discharge. Data from a comprehensive 2016 cross-sectional investigation in the UK demonstrated that 37.2% and 11.0% of participants experienced moderate and severe pain at the operative site, respectively, during the initial 24-hour postoperative period. Inadequate pain control can not only trigger multi-system complications such as myocardial ischemia, pulmonary infection, paralytic ileus, and urinary retention but also lead to psychological stress like anxiety and fear, significantly increasing patient morbidity and mortality. Notably, acute postoperative pain may progress to chronic pain lasting more than 3–6 months in approximately 10%–50% of patients. With the accelerating aging of the population and the increase in traffic accidents, the incidence of fractures is expected to continue rising, leading to a corresponding increase in orthopedic surgical volume and further burdening the healthcare system. Data analysis based on the US National Hospital Discharge Survey (NHDS) indicates that the annual incidence of falls in adults aged 65 and above is about 30% (reaching 50% for those over 80), with 10% resulting in severe injuries requiring medical intervention. US hospitalization data shows that among fall-related hospitalizations, fractures account for 84%, with hip fractures alone constituting 47.6% (lower limb fractures account for 13.0% in women and 8.8% in men). Despite advancements in fracture surgical techniques, moderate to severe acute postoperative pain remains prevalent, severely affecting patients’ physical and mental states and functional recovery. Therefore, exploring safe and effective perioperative pain management strategies is of significant clinical importance. Current postoperative analgesia primarily relies on opioids such as sufentanil, fentanyl, morphine, and hydromorphone, which produce analgesic effects by activating μ, δ, and κ G protein-coupled receptors. Hydromorphone, a semi-synthetic morphine derivative with approximately 5–10 times the analgesic potency of morphine, exerts its potent analgesic effect mainly by activating the μ receptor. Similar to traditional morphine, hydromorphone activates both G protein and β-arrestin pathways. Its metabolite, hydromorphone-3-glucuronide (H3G), may accumulate in patients with renal insufficiency and induce neuroexcitatory symptoms., Despite their efficacy in pain relief via G protein pathway activation, conventional μ-opioid receptor agonists concurrently stimulate the β-arrestin cascade. This unintended consequence precipitates significant adverse events, including respiratory depression and GI motility issues, thereby restricting their broader clinical utility. Oliceridine (TRV130) was developed as the first-in-class biased ligand, designed to activate G proteins selectively and attenuate β-arrestin recruitment. This mechanism allows it to maintain strong analgesia with a lower adverse reaction profile., Studies indicate that, unlike morphine, long-term use of oliceridine results in a diminished tolerance development. Phase I–III clinical assessments confirm that oliceridine achieves analgesia on par with morphine but with fewer occurrences of nausea, vomiting, and other GI-related side effects. However, current clinical research on oliceridine has primarily focused on abdominal and foot surgeries, with no systematic reports on its use for postoperative analgesia following lower limb fractures., This study aims to evaluate the efficacy and safety of oliceridine for postoperative analgesia following lower extremity fracture repair and compare it with used hydromorphone. We hypothesize that: (1) Oliceridine can provide effective analgesia for patients after lower limb fracture surgery with fewer adverse reactions and higher safety; (2) Compared to hydromorphone, oliceridine has non-inferior analgesic efficacy and a lower incidence of adverse reactions. The study findings are expected to provide a new pharmacological option and treatment strategy for moderate to severe postoperative pain associated with fractures.