Iipsilateral somatosensory and sympathetic nerve block are effective for analgesia and treatment of pain of unilateral originating from the chest and abdomen. Rhomboid intercostal block (RIB) is a plane block utilized to achieve post-operative analgesia following video-assisted thoracoscopic surgery (VATS). Objective: This randomized study was to done assess the total dose of post-operative morphine consumption and to compare the post-operative pain score (CHEOPS score) in the first post-operative 24 h, time to first rescue analgesia and intraoperative haemodynamic response to surgical stimuli. Methods: This was a prospective, randomized, double-blind controlled study aimed at comparison the post-operative analgesia with ultrasound guided- thoracic paravertebral block (TPVB) versus with ultrasound guided-RIB in children undergoing thoracoscopic sympathectomy. The study was conducted on 2 groups of children undergoing laparoscopic sympathectomy where 70 children were divided into two groups (each is 35 patients). Results: Duration of procedure demonstrated insignificant differences among both groups. Both groups demonstrated insignificant differences as regards heart rate and MAP either at baseline or at all intra-operative follow-up periods. Both groups demonstrated insignificant differences as regards all follow up periods of CHEOPS score. Both groups showed insignificant differences regarding analgesic requirement, 1st request of analgesia and morphine consumption. Conclusion: In the context of pediatric thoracoscopic sympathectomy, Ultra-sound guided rhomboid intercostal blockade could be considered as a promising approach which doesn't affect hemodynamics with comparable analgesic efficiency to thoracic paravertebral blockade