Abstract: Objective： To compare the efficacy and safety of butorphanol versus sufentanil， each combined with ketorolac tromethamine， for patient-controlled intravenous analgesia (PCIA) after total hysterectomy. Methods： Eighty-six patients scheduled for elective total hysterectomy from March 2022 to March 2025 were enrolled and randomly assigned to the control group or the observation group (n=43 each) using a random number table. Both groups received the same anesthesia induction and maintenance protocols， as well as preoperative ultrasound-guided transversus abdominis plane block (TAPB). Postoperatively， the control group received a PCIA regimen containing sufentanil (1.5 μg·kg-1) combined with ketorolac tromethamine (2 mg·kg-1)， while the observation group received ketorolac tromethamine (2 mg·kg-1) combined with butorphanol (0.1 mg·kg-1). Comparisons were made between the two groups regarding Visual Analogue Scale (VAS) scores for pain at rest and during cough at 6， 12， 24， 48 h postoperatively； the frequency of analgesic pump presses within 48 h； the total drug consumption from the PCIA pump； postoperative recovery and adverse reactions. Results： The VAS scores at rest and during cough significantly decreased over time at all postoperative time points in both groups (significant time effect， P<0.05). The observation group showed lower VAS scores than the control group at each time point (P<0.05). A significant interaction effect between time and group was observed (P<0.05). Compared with the control group， the observation group had a lower frequency of analgesic pump presses within 48 h， a shorter time to first ambulation， and a lower incidence of adverse reactions (P<0.05). Conclusion： For patients undergoing total hysterectomy with ultrasound-guided TAPB， a PCIA regimen combining butorphanol and ketorolac tromethamine can effectively alleviate postoperative pain， promote early ambulation， and reduce the incidence of adverse reactions.

Key words: font-size:medium, ">Butorphanol； Ketorolac tromethamine； Total hysterectomy； Patient controlled intravenous analgesia； Ultrasound guided transversus abdominis plane block