ObjectiveTo explore the safety and efficacy of thoracoscopic guided thoracic paravertebral block (TPVB) in resection of lung, and to provide strategies for enhanced recovery after surgery of lung. MethodsA total of 180 patients with thoracoscopic surgery of lung (including sublobar resection and lobectomy) hospitalized between May 2021 and June 2023 were included. Patients were divided into 3 groups. Patients received subcutaneous injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) on peripheral incision at chest closing were allocated into a Group A. Patients received ultrasound-guided injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) at the TPVB point after chest closing Group B. Patients received thoracoscopic guided injection of ropivacaine (concentration: 0.375%, dose: 2 mg/kg) before chest closing at the TPVB point Group C. The baseline data of each group were compared, and the effectiveness outcomes included perioperative adverse drug reactions, pain scores, postoperative analgesic drug use and postoperative hospital stay were compared among the 3 groups. ResultsThe mean age of patients in the three groups was (62.15±7.36) years, and 108 (60.0%) were females. There were no statistical differences in the baseline data of three groups, including age, weight, gender, incidence of previous underlying diseases, operation time, number of surgical incisions, number of drainage tubes inserted, and dosage of sufentanil or propofol used during surgery (P>0.05). There were no adverse anesthesia events in the 3 groups during the operation, the frequency of self-controlled intravenous analgesia pump in group C was lower than the other two groups (P<0.05), the VAS score in group C was lower than the other two groups (P<0.05), and the incidence of adverse reactions in group C was lower than the other two groups (P<0.05). The rate of postoperative analgesic drug use in group C was lower than the other two groups (P<0.05), and the days of hospital stay in group C and group B were lower than the group A (P<0.05). ConclusionThoracoscopic guided TPVB can reduce postoperative pain without increasing postoperative side effects, which had accelerated the enhanced recovery after surgery of lung.