Adverse Effects of Alfentanil versus Nalbuphine in Decompensated Cirrhotic Patients Undergoing Painless Gastroscopy: A Double-Blind, Randomized Controlled Trial

To compare nalbuphine versus alfentanil combined with etomidate-propofol for safety and efficacy during painless gastroscopy in decompensated cirrhosis patients. One hundred and seventy-five advanced cirrhosis patients were randomized to receive Nalbuphine (0.1 to 0.15 mg·kg-¹ IV bolus) or Alfentanil (5 to 6 μg·kg-¹ IV bolus). The primary outcome was the incidence of adverse events during and within 48 hours after gastroscopy. Other outcomes included hemodynamic parameters, BIS, adverse events and time during the PACU, first-attempt induction success, etomidate-propofol dosage, induction time, duration of gastroscopy, awakening time, along with the Aldrete score. Additionally, blood samples for ALT, AST, creatinine, and urea nitrogen were drawn within the first 24 hours after gastroscopy. The complication rates were 37.21% for nalbuphine and 11.24% for alfentanil group within 48 hours, exhibited a significantly difference (P = 0.00). Compared to the nalbuphine group, the RR of the alfentanil group was lower at T1 (post-induction stabilization, P = 0.03) and T2 (the end of procedure, P = 0.03). The SpO2 of the alfentanil group were lower at T1 (P = 0.01). The recovery time in alfentanil group was shorter (P = 0.01). Additionally, compared to pre-gastroscopy levels, the nalbuphine group showed significant decreases in serum ALT (P = 0.00) and AST levels (P = 0.00) postoperatively while alfentanil group exhibited significant reductions in ALT (P = 0.00) and BUN (P = 0.01) levels, along with a significant increase in Cr (P = 0.00). However, no significant differences existed in intraoperative or PACU complications, first-attempt induction success, dosage of etomidate-propofol, Aldrete score, induction time, operation time and awakening time (P > 0.05). Alfentanil demonstrates fewer postoperative complications and faster recovery than nalbuphine, potentially making it preferable for painless gastroscopy in decompensated cirrhosis.