Postoperative nausea and vomiting (
PONV) are one of the most adverse events after
general anesthesia, a distressing experience, and pose a risk to the patient. Despite advances in
drug prophylaxis and
PONV treatment, the incidence remains high and additional non-pharmacological treatments are needed. In this post hoc analysis of a recently published double-blind multicenter randomized controlled trial on the efficacy of intraoperative therapeutic suggestions on postoperative
opioid dosage, we analyzed the effects of intraoperative therapeutic suggestions on
PONV. We focus on patients with a high risk of
PONV (Apfel risk score of 3-4) and distinguished early (first two postoperative hours) and delayed
PONV (2-24 h). A total of 385 patients with a moderate or high risk for
PONV were included. The incidence of early and delayed
PONV was reduced (22.7-18.3 and 29.9-24.1%, respectively), without statistical significance, whereas in high-risk patients (n = 180) their incidence was nearly halved, 17.2 vs. 31.2% (p = 0.030) and 20.7 vs. 34.4% (p = 0.040), corresponding to a number needed to treat of 7 to avoid
PONV. In addition, there was a significant reduction in
PONV severity. In a multivariate logistic regression model, assignment to the control group (OR 2.2; 95% CI: 1.1-4.8) was identified as an independent predictor of the occurrence of early
PONV. Our results indicate that intraoperative therapeutic suggestions can significantly reduce the incidence of
PONV in high-risk patients. This encourages the expansion of therapeutic suggestions under
general anesthesia, which are inexpensive and virtually free of side effects. Clinical Trial Registration: German Clinical Trials Register, https://drks.de, registration number: DRKS00013800.