Abstract:Objective To investigate the effects of remimazolam combined with transversalis fascia plane block (TFPB) on postoperative pain and recovery in patients undergoing laparoscopic total hysterectomy.Methods A total of 120 patients who underwent laparoscopic total hysterectomy at our hospital between December 2024 and November 2025 were enrolled. Using a random number table, the patients were assigned to an observation group and a control group, with 60 patients in each group. All patients received general anesthesia, and neuromuscular blocking agents were discontinued 30 min before the end of surgery. In the observation group, propofol infusion was discontinued simultaneously with the neuromuscular blocking agents and replaced with a continuous infusion of remimazolam 0.3~1.0 mg/(kg·h) until the end of surgery. In the control group, anesthesia was maintained with propofol at 4.0~6.0 mg/(kg·h) after discontinuation of the neuromuscular blocking agents and continued until the end of surgery. After surgery, both groups underwent ultrasound-guided bilateral TFPB with 20 mL of 0.375% ropivacaine injected on each side. Following emergence from anesthesia, all patients received a patient-controlled analgesia pump containing sufentanil 2.0 μg/kg and ondansetron 16 mg, diluted with normal saline to a total volume of 100 mL. Perioperative analgesia-related outcomes were compared between the two groups. Visual analog scale (VAS) scores at rest and during movement were recorded at 2, 12, 24, and 48 h after surgery. Postoperative recovery-related outcomes were also evaluated. Pittsburgh Sleep Quality Index (PSQI), 40-item quality of recovery questionnaire (QoR-40), and mini-Mental State Examination (MMSE) scores were assessed before surgery and on postoperative day 1. Postoperative adverse events were compared between the two groups.Results The total intraoperative remifentanil consumption and the total number of analgesic pump activations within 48 h after surgery were lower in the observation group than those in the control group, whereas the time to the first postoperative analgesic pump activation was longer in the observation group, the differences were statistically significant (P < 0.05). No significant differences were observed between the two groups in total sufentanil consumption within 48 h after surgery or the incidence of rescue analgesia (P > 0.05). At all postoperative time points, VAS scores at rest and during movement were lower in the observation group than those in the control group, and the differences were statistically significant (P < 0.05). Compared with the control group, the observation group had shorter times to recovery of consciousness, tracheal extubation, discharge from the postanesthesia care unit (PACU), and first postoperative flatus, the differences were statistically significant (P < 0.05). On postoperative day 1, PSQI scores increased, whereas QoR-40 and MMSE scores decreased from their respective preoperative values in both groups, and the differences were statistically significant (P < 0.05). However, the magnitude of these changes was greater in the control group than in the observation group. The incidences of injection pain, nausea and/or vomiting, and dizziness were lower in the observation group than those in the control group, and the differences were statistically significant (P < 0.05). No significant differences were found between the two groups in the incidences of hypotension, respiratory depression, or bradycardia (P > 0.05).Conclusion Remimazolam combined with TFPB in patients undergoing laparoscopic total hysterectomy can effectively alleviate postoperative pain, reduce perioperative opioid consumption, facilitate emergence from anesthesia and postoperative functional recovery, and decrease the incidence of certain anesthesia-related adverse events.
