Thoracic paravertebral block (TPVB) technique for thoracotomy has seen increased application. The erector spinae plane block (ESPB) technique is simpler to perform than TPVB. However, whether it can be employed as a safe alternative analgesic technique has not been verified by a head-to-head clinical study.Ninety-four patients scheduled for thoracotomy lung surgeries were randomly allocated to an ESPB or TPVB group. Patients in both groups were provided with an intravenous patient-controlled analgesia (PCA) device containing sufentanil. Visual analogue scale (VAS) pain scores under the status of rest and cough were recorded at 1, 6, 12, and 24 h postoperatively. In addition, total press times of PCA were read from the PCA memory. The adverse effects, puncture time and success rate of one puncture were also recorded.There were no significant differences in pain scores at rest and cough between the ESPB and TPVB groups in each of the first two days after surgery, and no difference between the two groups was identified regarding postoperative sufentanil usage (P>0.05). There was no statistical difference in post-operative nausea and vomiting. There was significantly less hypotension (6.7% 21.7%, P=0.04), bradycardia (0 8.7%, P=0.04), hematoma (0 10.9%, P=0.02) and a higher success rate of one puncture (82.2% 54.3%, P<0.001) in the ESPB group.Preoperative single-injection ESPB plus postoperative sufentanil PCA provided similar effects of pain relief for patients undergoing thoracotomy when comparing to TPVB. Yet, ESPB had the advantages of a lower adverse effect incidence.