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Few studies have investigated the use of dexmedetomidine in patients with a high risk of postoperative nausea and vomiting (PONV) following gynaecological laparoscopic surgery.To investigate if the intra-operative use of dexmedetomidine could reduce the incidence of PONV in this patient population.A randomised, double-blind, placebo-controlled trial.A tertiary hospital in Beijing, China.130 adult patients scheduled for gynaecological laparoscopic surgery.Patients in the dexmedetomidine group (Dex group, n = 65) received a loading dose of dexmedetomidine (0.5 μg kg−1 over 10 min) before induction of anaesthesia, followed by a continuous infusion (0.1 μg kg−1 h−1) until the end of surgery. Patients in the control group (Ctrl group, n = 65) received volume-matched normal saline. Propofol and remifentanil were used for induction and maintenance of anaesthesia. Intravenous patient-controlled analgesia with morphine was provided after surgery.The incidence of 24-h PONV.The incidence of nausea within the first 2 postoperative hours was lower in the Dex group than in the Ctrl group [0% (0/65) vs. 9% (6/65), P = 0.037]. The overall incidence of PONV within the first 2 postoperative hours was slightly lower in the Dex group than in the Ctrl group, but the difference was not statistically significant [5% (3/65) vs. 14% (9/65), P = 0.069]. There was no significant difference between the two groups regarding the incidence of 24-h PONV.For adult patients undergoing gynaecological laparoscopic surgery, supplemental use of dexmedetomidine during general anaesthesia reduced the incidence of early postoperative nausea but not vomiting within the 24 h after surgery.Chinese Clinical Trial Registry ChiCTR-IPR-15006914.