Background: There is no consensus on the clinical postoperative analgesic effects of thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in randomized controlled trials (RCTs). Therefore, systemic review and meta-analysis were conducted based on the existing randomized controlled studies related to the comparison between TPVB and ESPB. Methods: PubMed, Embase, MEDLINE, Science Direct, The Cochrane library, Google scholar, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Sci-tech Periodicals Database were searched by computers. Chinese and English search keywords included Thoracic paravertebral block, TPVB, Erector spinae plane block, ESPB, video-assisted thoracic surgery, VATS, and thoracoscopic surgery and postoperative analgesia. Rev Man 5.3 offered by Cochrane collaboration net was utilized to assess the quality and risks of included articles. Results: A total of 10 articles were included. The analgesia scores for TPVB group and ESPB group 12 hours and 24 hours after surgery were different. The scores 12 hours after surgery were as follows: Standard mean difference (SMD) was -0.77 with 95% confidence interval (CI) (-1.40, -0.14), and P=0.02. The scores 24 hours after surgery were as follows: SMD were -0.64 with 95% CI (-0.98, -0.30), and P=0.0002. The total consumption of equivalent morphine 24 hours after surgery between ESPB and TPVB groups did not show statistical differences. Mean difference (MD) was -2.32 with 95% CI (-4.92, 0.28), and P=0.08. Besides, the incidence of postoperative nausea and vomiting between TPVB and ESPB groups did not demonstrate significant statistical differences. Relative ratio (RR) was 0.90 with 95% CI (0.52, 1.54), and P=0.70. In addition, postoperative rescue analgesia times between TPVB and ESPB groups revealed remarkable statistical differences. RR was 0.46 with 95% CI (0.30, 0.71), and P=0.0004. Conclusion: The results of meta-analysis confirmed that the pain scores of clinical postoperative analgesia by TPVB during cough 12 hours and 24 hours after surgery were lower than that by ESPB. Postoperative rescue analgesia was obvious, and a more precise analgesic effect was shown