Objective Exploring the effects of different concentrations of ropivacaine on the postoperative analgesic efficacy and stress response in patients undergoing laparoscopic total hysterectomy using the arcuate ligament lumbar muscle block. Methods Between January 2023 and December 2024， a total of 285 patients undergoing elective laparoscopic total hysterectomy were selected from the hospital. These patients were randomly divided into three groups （Group A， Group B， Group C） with the application of a random number table， with 95 patients in each group. Prior to anesthesia in Group A， bilateral arcuate ligament lumbar muscle block was performed， and 0.25% ropivacaine was administered； Group B was given 0.375% ropivacaine； Group C was given 0.5% ropivacaine. Compare three sets of surgical indicators， pain scores， stress indicators， hemodynamic indicators， and incidence of adverse reactions. Results The dose of sufentanil administered via infusion to patients in Groups B and C was lower than that given to those in Group A （P < 0.05）； After surgery， the pain scores of Group B and Group C were lower than those of Group A （P < 0.05）； On postoperative day 1， the levels of cortisol （Cor）， C-reactive protein （CRP）， and adrenocortical hormone （ACTH） in groups B and C were lower than those in group A （P < 0.05）； The average arterial pressure and heart rate of the three groups were compared pairwise at 30 minutes after surgery and after surgery， and the differences were statistically significant. The changes in average arterial pressure and heart rate of groups B and C were smaller than those of group A （P < 0.05）； The differences among the three groups were not statistically significant （P > 0.05）. Conclusions 0.375% and 0.5% ropivacaine have equal analgesic effects and are both superior to 0.25% concentration. Therefore， it is recommended to use 0.375% as the preferred clinical concentration to ensure excellent analgesia while the incidence of adverse reactions is low.