{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:46:32Z","timestamp":1785818792226,"version":"3.56.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative nausea and vomiting (PONV) is common after painless gastroscopy. The independent predictive value of preoperative albumin, total bilirubin, Apfel score, and opioid type for PONV in decompensated cirrhosis is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In this exploratory post-hoc secondary analysis of a double-blind randomized controlled trial, we aimed to determine whether preoperative albumin, total bilirubin, Apfel score, and opioid type (alfentanil vs. nalbuphine) independently predict PONV within 48\u00a0h after painless gastroscopy in decompensated cirrhosis, and to compare their effects on 24\u00a0h postoperative liver function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall incidence of PONV was 24.00%, significantly higher with nalbuphine (P &amp;lt; 0.001). Univariate analysis: PONV patients were older (P = 0.012); no differences in preoperative albumin, total bilirubin, or Apfel score (all P &amp;gt; 0.05). Multivariable regression: preoperative albumin and total bilirubin were not independent predictors (both P &amp;gt; 0.05). Each 1-point increase in Apfel score gave (OR 1.40, 95% CI: 0.92\u20132.13; P = 0.116). Alfentanil significantly reduced PONV risk vs. nalbuphine (OR = 0.19, 95% CI: 0.08\u20130.47; P &amp;lt; 0.001); sensitivity analysis adjusted for age gave OR 0.20 (95% CI: 0.08\u20130.49; P &amp;lt; 0.001). Postoperatively, total bilirubin increased significantly in both groups (P &amp;lt; 0.05), whereas albumin showed no significant changes (P &amp;gt; 0.05). These mild fluctuations were comparable between the alfentanil and nalbuphine groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative albumin, total bilirubin and Apfel score did not independently predict PONV. Alfentanil was independently associated with a significantly reduced risk of PONV compared to nalbuphine. Postoperative liver function changes were mild, similar between groups and unrelated to PONV. Our findings are hypothesis-generating and require confirmation in larger studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1865501","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:27:49Z","timestamp":1785817669000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Opioid type, rather than liver function, is associated with postoperative nausea and vomiting after painless gastroscopy in decompensated cirrhosis"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiao-Yu","family":"Gu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, NO.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Feng","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NO.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin-Yang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NO.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu-Qin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NO.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1097\/00000542-199909000-00022","article-title":"A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers","volume":"91","author":"Apfel","year":"1999","journal-title":"Anesthesiology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1034\/j.1399-6576.2002.460801.x","article-title":"How to study postoperative nausea and vomiting","volume":"46","author":"Apfel","year":"2002","journal-title":"Acta Anaesthesiol. Scand."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1080\/02664763.2024.2418473","article-title":"Evaluating the median p -value method for assessing the statistical significance of tests when using multiple imputation","volume":"52","author":"Austin","year":"2025","journal-title":"J. Appl. Statistics"},{"key":"B4","doi-asserted-by":"publisher","first-page":"621","DOI":"10.2217\/pgs-2017-0002","article-title":"OCT1 genetic variants are associated with postoperative morphine-related adverse effects in children","volume":"18","author":"Balyan","year":"2017","journal-title":"Pharmacogenomics"},{"key":"B5","doi-asserted-by":"publisher","first-page":"102205","DOI":"10.1016\/j.clinre.2023.102205","article-title":"Anesthesia in patients with chronic liver disease: an updated review","volume":"47","author":"Bedewy","year":"2023","journal-title":"Clin. Res. Hepatology Gastroenterology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1213\/00000539-198208000-00006","article-title":"Pharmacokinetics of alfentanil in man","volume":"61","author":"Camu","year":"1982","journal-title":"Anesth. and Analgesia"},{"key":"B7","doi-asserted-by":"publisher","first-page":"102350","DOI":"10.1016\/j.ejon.2023.102350","article-title":"External validation of postoperative nausea and vomiting risk scores in patients with liver cancer: a single-centre prospective cohort study","volume":"65","author":"Chen","year":"2023","journal-title":"Eur. J. Oncol. Nurs."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1186\/s12885-025-14592-0","article-title":"Duration of hepatic portal occlusion is a valuable predictor for postoperative nausea and vomiting in patients underwent liver resection for liver cancer","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Cancer"},{"key":"B9","doi-asserted-by":"publisher","first-page":"106885","DOI":"10.1016\/j.ejps.2024.106885","article-title":"Effect of protein binding on the pharmacokinetics of the six substrates in the basel phenotyping cocktail in healthy subjects and patients with liver cirrhosis","volume":"202","author":"Duthaler","year":"2024","journal-title":"Eur. J. Pharm. Sci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1124\/dmd.120.000152","article-title":"Scaling factors for clearance in adult liver cirrhosis","volume":"48","author":"El-Khateeb","year":"2020","journal-title":"Drug Metabolism Dispos."},{"key":"B11","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth consensus guidelines for the management of postoperative nausea and vomiting","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth. and Analgesia"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007816","article-title":"Fifth consensus guidelines for the management of postoperative nausea and vomitting: executive summary","author":"Gan","year":"2025","journal-title":"Anesth. and Analgesia"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2383","DOI":"10.2147\/DDDT.S371596","article-title":"Pharmacokinetic study of nalbuphine in surgical patients undergoing general anesthesia with varying degrees of liver dysfunction","volume":"16","author":"Gao","year":"2022","journal-title":"DDDT"},{"key":"B14","doi-asserted-by":"publisher","first-page":"7415","DOI":"10.2147\/DDDT.S540089","article-title":"Adverse effects of alfentanil versus nalbuphine in decompensated cirrhotic patients undergoing painless gastroscopy: a double-blind, randomized controlled trial","volume":"19","author":"Gu","year":"2025","journal-title":"DDDT"},{"key":"B15","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/00044067-200507000-00003","article-title":"The endogenous opioid system and clinical pain management","volume":"16","author":"Holden","year":"2005","journal-title":"AACN Clin. Issues Adv. Pract. Acute Crit. Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e068405","DOI":"10.1136\/bmjopen-2022-068405","article-title":"Preoperative hypoalbuminaemia in liver surgery: an observational study at a university medical centre","volume":"13","author":"Kuhlmann","year":"2023","journal-title":"BMJ Open"},{"key":"B17","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1186\/s41043-025-01109-5","article-title":"Global burden of liver cirrhosis: trends from 1990\u20132021 and projections to 2060","volume":"44","author":"Luo","year":"2025","journal-title":"J. Health Popul. Nutr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1968","DOI":"10.14309\/ajg.0000000000003616","article-title":"ACG clinical guideline: perioperative risk assessment and management in patients with cirrhosis","volume":"120","author":"Mahmud","year":"2025","journal-title":"Am. J. Gastroenterol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1111\/trf.16844","article-title":"Hemodilution in high\u2010risk cardiac surgery: laboratory values, physiological parameters, and outcomes","volume":"62","author":"Mladinov","year":"2022","journal-title":"Transfusion"},{"key":"B20","doi-asserted-by":"publisher","first-page":"471","DOI":"10.3390\/metabo14090471","article-title":"Disposition of oral nalbuphine and its metabolites in healthy subjects and subjects with hepatic impairment: preliminary modeling results using a continuous intestinal absorption model with enterohepatic recirculation","volume":"14","author":"Nagar","year":"2024","journal-title":"Metabolites"},{"key":"B21","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/LVT.0000000000000388","article-title":"Opioid use and risks in candidates and recipients of liver transplant","volume":"31","author":"Rubin","year":"2025","journal-title":"Liver Transplant."},{"key":"B22","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.ejphar.2013.09.074","article-title":"Opioid induced nausea and vomiting","volume":"722","author":"Smith","year":"2014","journal-title":"Eur. J. Pharmacol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2328521","DOI":"10.1080\/07853890.2024.2328521","article-title":"Global burden of liver cirrhosis 1990\u20132019 and 20 years forecast: results from the global burden of disease study 2019","volume":"56","author":"Wang","year":"2024","journal-title":"Ann. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: issues and guidance for practice","volume":"30","author":"White","year":"2011","journal-title":"Stat. Med."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1865501\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:27:49Z","timestamp":1785817669000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1865501\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":24,"alternative-id":["10.3389\/fphar.2026.1865501"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1865501","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"article-number":"1865501"}}