Background: Breast surgery is typically carried out under general anesthesia and is linked to significant post-operative nausea, vomiting, and pain (PONV), as well as immunological, psychological, and physical distress.The present study compared thoracic epidural block and paravertebral block in patients of breast surgery. Materials & Methods: 56 females undergoing unilateral breast surgerywere divided into 2 groups of 28 each. Group I patients received thoracic epidural single shot at T4 level using 2ml/segment of 0.5% ropivacaine and group II patients received thoracic single shot paravertebral block at T2 level using 0.3 ml/kg of 0.5% ropivacaine. Parameters such as mean blood pressure, respiratory rate, Ramsey sedation score, performance time, induction time, duration of surgery, total propofol required, total fentanyl required etc. was recorded. Results: Total propofol required (mg) was 124.6 and 142.5, total fentanyl required (µg) was 121.2 and 124.8, total fluid (RL) required (l) was 1.91 and 1.51, time to rescue analgesic (min) was 304.4 and 302.2, patient satisfaction score was 88.5 and 86.2, duration of surgery (min) was 71.2 and 70.0, performance time (min) was 7.24 and 6.22, systolic blood pressure (mm Hg) was 112.6 and 124.4, respiratory rate (breadth/min) was 22.1 and 18.3, Ramsey sedation score was 1.71 and 1.69, induction time (min) was 15.7 and 16.4 in group I and II respectively (P< 0.05). Side effects were nausea/ vomiting in 6 in group I and 2 in group II. Hypotension requiring vasopressors was seen in 4 in group I and 1 in group II. The difference was significant (P< 0.05). Conclusion: Both epidural and paravertebral blocks offer the best analgesic and surgical conditions, as well as high patient satisfaction.