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Background: Haloperidol, a major tranquilizer similar to droperidol,has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the supporting evidence was incomplete, especially in Korea. Therefore we evaluated the prophylactic effect of haloperidol on opioid-based IV patient-controlled analgesia (PCA) related PONV in susceptible patients after gynecological laparoscopic surgery. Methods: Ninety-six adult women scheduled gynecological laparoscopic surgery were enrolled in a randomized, double-blinded and placebo study. Patients received haloperidol 1 mg (Group H) or saline (Group C) 30 min before the end of surgery. Fentanyl-based IV PCA was administered after surgery. The incidences and severity of nausea, vomiting, rescue antiemetic administration, pain,and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed for 24 h after surgery. The sedation score was recorded in the post-anesthesia care unit for 2 h. Results: The incidences and severity of nausea and the number of antiemetic administration were significantly lower in Group H than Group C (P < 0.05). But the sedation and pain score were similar. There was no QTc prolongation or extrapyramidal symptom in both groups. Conclusions: Prophylactic haloperidol 1 mg is effective in preventing PONV related to fentanyl-based IV PCA, with less adverse effects, in patients undergoing gynecological laparoscopic surgery.