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Female patients undergoing gynaecological procedures, especially laparoscopically, are at high risk of postoperative nausea and vomiting. No available antiemetic is entirely effective. This double-blinded randomized trial examines the efficacy and safety of tropisetron and metoclopramide in combination and compares the results with metoclopramide alone in laparoscopic gynaecological surgery.One hundred and twenty female patients scheduled for minor gynaecological laparoscopy, aged 27–43 years, were randomly allocated to receive pretreatment with metoclopramide 10 mg intravenously (n =57) or tropisetron 5 mg with metoclopramide 5 mg (n =63).Fewer patients in the combined treatment group experienced postoperative nausea and vomiting (14% vs. 37%, P =0.008) or needed rescue antiemetic treatment (3% vs. 16%, P =0.038). No significant adverse events were observed.The combination of the antiemetics was superior, which is probably explained by the fact that the two drugs have different sites of action, thus preventing emesis by blocking different pathways.