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Below, we have prepared a point-by-point response to address the concerns raised.  \nResponse to the Letter  \nDose Selection and Correction of Ulinastatin (UTI) Dosage Error  \nWe fully acknowledge the comment regarding the reported UTI dosage. The value “30 IU” was indeed an error; the correct dosage is 300,000 IU. This inaccuracy resulted from a unit conversion oversight during manuscript preparation (omission of the term “” [ten-thousand]) . We sincerely apologize for this error and will correct it promptly in the final revised manuscript.  \n● Rationale for Dose Selection: The single preoperative dose of 300,000 IU was selected based on established clinical practice and pharmacological studies. Multiple references indicate that the commonly used clinical dosage of UTI ranges between 100,000 and 500,000 IU (or 10,000 U/kg) .1–4 Furthermore, preclinical studies using a rat incisional pain model demonstrated that a single preoperative dose within this range effectively reduced postoperative mechanical hypersensitivity.5 Our own pilot data confirmed that this dosage offered an optimal balance between efficacy and safety.  \n● Future Refinement: We agree with the suggestion to include multiple dosing groups (eg, 100,000 IU, 300,000 IU, 500,000 IU) in future trials to identify the optimal regimen. Additionally, incorporating pharmacokinetic data (eg, plasma concentration-time curves) would further substantiate dose justification.  \nReceived: 13 December 2025  \nAccepted: 19 December 2025  \nPublished: 31 December 2025  \nJournal of Pain Research 2025:18 7195–7197 7195  \n© 2025 Wang and Li. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at [https://www.dovepress.com/terms](https://www.dovepress.com/terms).  \nphp and incorporate the Creative Commons Attribution – Non Commercial (unported, v4.0) License ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ([https://www.dovepress.com/terms.php](https://www.dovepress.com/terms.php)).  \nImbalance in Stroke History After Randomization  \nWe acknowledge the observed imbalance in stroke history between the flurbiprofen axetil (FA) group (20%) and the control group (2%) . Although the trial was double-blinded and randomized, this discrepancy could potentially confound secondary outcomes such as delirium incidence. Below we provide a point-by-point response:  \n● Stringent","cbCaigNBJP5gdjMJ","https://ap.wps.com/l/cbCaigNBJP5gdjMJ","pdf",322426,"English","# Response to the Letter\n## Dose Selection and Correction of Ulinastatin Dosage Error\n## Rationale, Future Refinement, and Supplementary Dosing Plans\n## Imbalance in Stroke History After Randomization\n## Supporting Delirium and Stratification Analyses\n## Conclusion","[{\"question\":\"What dosage error is corrected regarding ulinastatin in the response?\",\"answer\":\"The reported value “30 IU” was an error; the correct UTI dosage is 300,000 IU. The mistake came from a unit conversion oversight during manuscript preparation.\"},{\"question\":\"How is the chosen single preoperative UTI dose justified?\",\"answer\":\"A single 300,000 IU dose is supported by established clinical practice and pharmacological studies showing common UTI ranges of 100,000 to 500,000 IU, as well as preclinical evidence using an incisional pain model.\"},{\"question\":\"How does the authors’ response address the imbalance in stroke history after randomization?\",\"answer\":\"The response notes exclusion criteria aimed to minimize confounding stroke-related cognitive sequelae, reports that delirium incidence is significantly lower in the UTI group, and describes post hoc stratification by stroke history (with limited conclusions in the very small stroke-history subgroup).\"}]","Efficacy and Safety Comparison of Ulinastatin Versus Flurbiprofen Axetil for Preemptive Analgesia in Reducing Opioid Burden After Total Knee Arthroplasty - Response to Letter | PDF",1790666682]