Abstract: Objective To compare the efficacy and safety of erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) in preventing acute post-surgical pain syndrome (PSP) OF BREAST CANCER. Methods The following databases, both domestic and international, including Embase, Cochrane Library, Web of Science, PubMed, CNKI, VIP, Wanfang, and Sinomed, were searched via computer to gather clinical randomized controlled trials (RCTs) on ESPB and TPVB for breast cancer patients. The included literature was evaluated using the Cochrane bias risk assessment tool to assess quality, and meta-analysis was performed using Review Manager 5. 4 software and Stata 17. 0 software. Results This study comprised 14 RCTs, with a total of 1079 patients, including 540 ESPB patients and 539 TPVB patients. The analysis results indicated that there was a significant difference in pain scores during postoperative rest between ESPB and TPVB during 3-4 h (I²=53%, SMD=0. 36, 95% CI:0. 07-0. 65, P=0. 020) and 5-6 h (I²=80%, SMD =0. 53, 95% CI:0. 05-1. 01, P=0. 030), with TPVB being superior to ESPB. However, there was no significant difference in pain scores during postoperative rest between ESPB and TPVB at 1-2 h (I²=75%, SMD =0. 28, 95% CI:-0. 03-0. 60, P=0. 080), 7-8 h (I²=89%, SMD=0. 24, 95% CI:-0. 47-0. 94, P= 0. 510), 12 h (I²=90%, SMD=0. 1, 95% CI:-0. 40-0. 60, P=0. 690), 24 h (I²=78%, SMD=0. 33, 95% CI:-0. 04-0. 70, P=0. 080), and 48 h (I²=85%, SMD=-0. 05, 95% CI:-0. 52-0. 42, P= 0. 830). For the pain score during postoperative exercise, there was a significant difference between ESPB and TPVB during 3-4 h (I²=0, SMD=0. 29, 95% CI:0. 09-0. 48, P=0. 004), 7-8 h (I²=48%, SMD= 0. 37, 95% CI:0. 00-0. 73, P=0. 050), and 48 h (I²=0, SMD=0. 21, 95% CI:0. 03-0. 39, P= 0. 020), with TPVB being superior to ESPB. There was no significant difference between ESPB and TPVB at 1-2 h (I²=89%, SMD=0. 42, 95% CI:-0. 19-1. 03, P=0. 180), 5-6 h (I²=90%, SMD=0. 29, 95% CI:-0. 67-1. 24, P=0. 560), 12 h (I²=81%, SMD=0. 25, 95% CI:-0. 22-0. 72, P=0. 300), and 24 h (I²=83%, SMD=0. 39, 95% CI:-0. 10-0. 89, P=0. 120). There was a statistical difference in the operation time of nerve blocks between the two methods, with ESPB taking less time than TPVB (P<0. 001). However, there was no statistical difference in opioid consumption within 24 h after surgery, incidence of nausea and vomiting, and the first PCIA press time (all P> 0. 05). Conclusions Compared to ESPB, TPVB tends to result in a decreased pain score after breast cancer surgery, but it also took longer to perform. There was no significant difference between the two methods in terms of opioid consumption at 24 h after surgery, incidence of nausea and vomiting and the first PCIA press time.