The vote, held for the 14th consecutive year, was 182 to four with one abstention on a resolution calling for Washington to lift the US trade, financial and travel embargo, particularly its provisions penalising foreign firms.
The four voting no were the United States, Israel, Palau and the Marshall Islands. Micronesia abstained and El Salvador, Iraq, Nicaragua and Morocco did not vote. Last year the vote was 179 to five, with more countries refusing to vote.
Cuba has been under a US embargo since President Fidel Castro defeated a CIA-backed assault at the Bay of Pigs in 1961.
Friends of the United States, including Canada, Japan, Australia voted yes, although the European Union strongly criticised Cuba's human rights record.
The measure is non-binding and has had no impact on the United States, with the Bush administration having tightened restrictions against Cuba.
But the resolution has given Cuba a morale boost each year, especially from nearly all South American and Caribbean nations, particularly Mexico.
Critics of the embargo say it has failed to bring change to Cuba and allows Castro to blame the nation's economic woes on the United States.
Cuban Foreign Minister Felipe Perez Roque highlighted regulations tightening the use by Americans of Cuban products abroad, presumably smoking a Cuban cigar or drinking rum.
"In terms of insanity, this draconian prohibition should go into the annals of the Guinness Book of Records," he said.
The United States for the first time downplayed the entire debate that included more than two dozen speakers. Its envoy, Ronald Godard, used a procedure allowing him to make a short speech from his seat.
"If the people of Cuba are jobless, hungry or lack medical care, as Castro admits, it is because of his economic mismanagement, not the embargo," Godard said.