Opioid-free anaesthesia reduces postoperative nausea and vomiting after thoracoscopic lung resection. Comment on Br J Anaesth; 132: 267–76

Editor—By conducting a multicentre, randomised controlled double-blind trial of 120 subjects who underwent thoracoscopic lung resection, Feng and colleagues1 demonstrated that surgical pleth index-guided opioid-free anaesthesia (OFA) halved the incidence of postoperative nausea and vomiting (PONV) (15.0% vs 31.7%). However, PONV was defined as any episode of nausea, retching, or vomiting during the first 48 h after surgery. Their overall definition of PONV, encompassing any episode of nausea, retching, or vomiting, might have risked the inclusion of 'clinically less important' PONV.