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We performed a randomised, double‐blind study to evaluate the effect of the pre‐emptive use of minimal dose intravenous fentanyl (25 μg) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Six hundred patients were randomly assigned to one of three groups to receive either 0.5 ml saline 0.9% 1 min before administration of fentanyl 150 μg (3 ml), or pre‐emptive fentanyl 25 μg (0.5 ml) 1 min before administration of fentanyl 125 μg or 150 μg. The incidence of fentanyl‐induced cough was significantly lower in both pre‐emptive groups (7 (3.5%) for 125 μg fentanyl and 15 (7.5%) for 150 μg fentanyl) than in the saline group (37 (18.5%); p = 0.001). We conclude that pre‐emptive use of fentanyl 25 μg, administered 1 min before bolus injection of fentanyl (125 or 150 μg), can effectively suppress fentanyl‐induced cough.