Thoracic epidural anesthesia (TEA) is a widely used technique for analgesia after thoracic surgery.However, it has several adverse effects. The erector spinae plane block (ESPB) is a relatively simple and safe technique. This study aimed to compare the analgesic efficacy of ESPB and TEA.Patients who underwent video-assisted thoracic surgery (VATS) were assigned to either the ESPB or TEA group. Numerical Rating Scale (NRS) pain scores were recorded at rest and during movement in both groups until 2 days after surgery. Adverse effects were also recorded.Although the average NRS score in the ESPB group was less than 2 at rest and less than 4 during movement, these scores were significantly higher than those in the TEA group. There were significantly fewer patients with hypotension in the ESPB group. The ESPB is associated with low NRS scores and provides effective pain relief in patients undergoing VATS. The ESPB has the advantage of conferring a lower incidence of adverse effects.