Laparoscopic cholecystectomy is a surgical lesion, despite advances in surgery allowing access with minimally invasive, pain is a constant in this and other procedures. The injury results in a surgical trauma which produces - inevitably - nociceptive sensitisation which translates in postoperative pain after a complex mechanism (1); pain constitutes then an unpleasant emotional response to the patient who undergoes a surgery and a constant concern for the anesthesiologist, surgeon and his team.

 

More than 84% of patients undergoing surgery of any kind, express some degree of pain in the postoperative period and require additional analgesic dose, regardless of the intensity of the pain, its presence is important not only because of its frequency, but also because that triggers postoperative complications linked to respiratory problems and directly impacts on recovery, time of labor reintegration (social) and quality of life of patients.

 

The goal to undertake a surgical procedure must be realized to achieve an ideal that would be the comfort of the patient (patient pain-free) fact that today as old challenge for science and specialist.

 

The study of pain by Pharmacology and neuroscience suggests that the administration of analgesics prior to the production of a nociceptive, stimulus would be more effective than the same dose given after the stimulus; there are many ways to block the cascade of pain(2.3). Modern treatment of pain peri operative aims reduce the unpleasant emotional response which translates into suffering for the patient, thereby, promote recovery and early rehabilitation to normal activities.

 

"In recent years the interest in improving pain control avoiding it before trying it (preventive analgesia) has gained particular attention in the scientific community"(4), idea based on the concept that an unpleasant effect prevention is better than treatment.

 

Preventive analgesia is an alternative to help control the pain in the postoperative period. If one takes into account the physiology of pain, the application of an NSAID that blocks the way nociceptive pain before the injury occurring (5, 6) and the infiltration of local anesthetic that blocks transmission could prevent the existence of the pain or reduce its intensity and would significantly improve the quality of postoperative analgesia (5,6).

 

There are publications that support the use of preoperative ketorolac, and, separately, the use of a local anesthetic Ropivacaine or Levobupivacaine with encouraging results(7, 8.9). But must assess this analgesic application efficiency, and above all, the administration of ketorolac combination analgesic response administered by venous via and Ropivacaine infiltrated prior to placement of trocars in patients undergoing laparoscopic cholecystectomy.