Background <p>Thoracic epidural analgesia (TEA) is the gold standard for analgesia after thoracotomy, but it has limitations. There are few studies on the analgesic effect of ultrasound-guided paravertebral nerve block (PVB) combined with general anesthesia in esophageal cancer surgery.</p> Methods <p>52 TLE patients from November 2020 - November 2021 were randomly divided into Group G (general anesthesia, <i>n</i> = 26) and Group G + P (ultrasound - guided PVB + general anesthesia, <i>n</i> = 26). General data, intraoperative/postoperative indicators, VAS scores, HR, MAP, NTI, and patient satisfaction were recorded.</p> Results <p>There were no significant differences in general data such as age, gender, BMI, and ASA grade between the two groups (<i>P</i> &gt; 0.05). The intraoperative dosages of propofol, remifentanil, and sufentanil in Group G + P were significantly lower than those in Group G, while the dosage of phenylephrine was higher. The extubation time, PACU stay time, and postoperative hospital stay in Group G + P were shorter, the dosage of sufentanil in PACU was less, and the incidence of agitation was lower. The VAS scores of Group G + P in the resting and coughing states at multiple time points such as waking up, leaving the PACU, and after surgery were significantly lower than those of Group G. There was no significant difference in HR between the two groups at most time points during the operation. The MAP of Group G was higher than that of Group G + P at time points t8 and t9, and there were significant differences in NTI between the two groups from t2 to t7. The satisfaction rate of patients in Group G + P (96.14%) was significantly higher than that in Group G (80.76%).</p> Conclusion <p>Ultrasound - guided PVB combined with general anesthesia reduces opioid use, eases pain, lowers agitation, shortens hospital stay, and boosts satisfaction in esophageal cancer surgery patients.</p>