The inflammatory process is the main mechanism in the occurrence of acute postoperative pain. It is also the main risk for the development of acute pain into persistent pain. Inflammation occurs in the process of peripheral sensitization and central sensitization with various inflammatory mediators. Postoperatively, there will be proliferation and activation of microglia and astrocytes which will then activate inflammatory receptors and signaling cascades of neurotransmitters, cytokines, and chemokines. There has been a lot of clinical research evidence that multimodal analgesia can adequately treat acute pain and can prevent the development of acute postoperative pain into persistent pain and chronic postoperative pain, but the molecular mechanisms are not fully understood.

Inclusion Criteria:

• Scheduled for elective hysterectomy
• American Society of Anesthesiologists (ASA) physical status 1 to 3

Exclusion Criteria:

• allergy to studied drugs
• history of chronic pain
• history of hepatitis, depression, peptic ulcer, or acute myocardial infarction
• receive intraoperative massive blood transfusion
• prolonged coagulation
• body mass index >35 kg/m2
• patients with neurological deficits
• taking anti-platelet medications