To investigate the clinical effect of the different concentrations of ropivacaine in the gynecological transversal muscle plane (TAP) block under ultrasound guidance. Methods: A total of 105 patients who wanted total laparoscopic hysterectomy under general anesthesia in hospital were included in the study and were divided into group A, group B and group C according to the double-blind method from April 2021 to April 2023. The patients in group A, group B and group C were given 0.25%, 0.3% and 0.375% ropivacaine in TAP block during hysterectomy, respectively. The operation related indexes, the changes of the scores of the pain and comfort at different time points, the levels of inflammatory factors before and after anesthesia and the occurrence of adverse reactions in 24h after operation of the patients were compared among the three groups. Results: There were no significant differences in the anesthesia time, the intraoperative blood loss, and the operation time of the patients among the three groups (P>0.05). The visual analogue scale (VAS) score of the patients in the three groups in 24h after operation was significantly lower than that in 1h after operation, and the Bruggrmann comfort score (BCS) of the patients in the three groups in 24h after operation was significantly higher. The VAS score (1.56±0.51 points) of the patients in group C was significantly lower than that (2.69±1.02 points) of the patients in group A and that (2.35±0.68 points) of the patients in group B. The BCS score (3.24±0.54 points) of the patients in group C was significantly higher than that (2.23±0.39 points) of the patients in group A and that (2.59±0.41 points) of the patients in group B (P<0.05). After anesthesia, the levels of C-reactive protein (CRP) and the tumor necrosis factor-α (TNF-α) of the patients in the three groups had increased significantly. The levels of CRP (21.36±4.26 mg/L) and TNF-α (70.13±7.16 pg/ml) of the patients in group C were significantly lower than those (28.98±5.62 mg/L and 96.54±8.97 pg/ml) of the patients in group A and those (24.69±4.87 mg/L and 84.33±7.62) of the patients in group B. The incidence of adverse reactions (8.6%) of the patients in group C was significantly lower than that (40.0%) of the patients in group A and that (31.4%) of the patients in group B (all P<0.05). Conclusion: Ropivacaine with 0.375% concentration used in gynecological TAP block under ultrasound guidance of the patients has the significant effect on alleviating the pain and on improving the postoperative comfort of the patients, and which can help to reduce the risk of the postoperative adverse reactions and to increase the medicine safety of the patients.