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Hartmuth Sebastian Burkhard Nowak, Alexander Wolf, Tim Rahmel, Günther Oprea, Lisa Grause, Manuela Möller, Katharina Gyarmati, Corinna Mittler, Alexandra Zagler, Katrin Lutz, Johannes Loeser, Thomas Saller, Michael Tryba, Michael Adamzik, Ernil Hansen, Nina Zech

• 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 \(\textit {post hoc}\) 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 (\(\it n\) = 180) their incidence was nearly halved, 17.2 vs. 31.2% (\(\it p\) = 0.030) and 20.7 vs. 34.4% (\(\it p\) = 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.