BACKGROUND: Ultrasound-guided intercostal nerve block (UINB) and thoracoscopic-guided intercostal nerve block (TINB) are often used for analgesia after thoracic surgery. Herein, we compared the application of TINB and UINB for analgesia after uniportal video-assisted lobectomy. METHODS: Sixty patients were randomly allocated into two groups: UINB and TINB. The surgical time of intercostal nerve block (INB), the success rate of the first needle, visual analog scale (VAS) scores, the time of the first patient-controlled intravenous analgesia (PCIA) press, the time for removing the thoracic drainage tube, consumption of sufentanil and the number of PCIA presses within 24 hours postoperatively, and adverse reactions (ARs) were compared between the two groups. RESULTS: The surgical time of INB was significantly shorter in the TINB group than in the UINB group ( P <
0.001). The time of the first press of PCIA was significantly earlier in the TINB group than in the UINB group ( P <
0.001). The success rate of the first needle was significantly higher in the TINB group than in the UINB group ( P <
0.001). No significant differences were observed between the two groups regarding VAS scores, time for removing the thoracic drainage tube, the consumption of sufentanil, the number of PCIA presses within 24 hours postoperatively, and ARs. CONCLUSION: TINB and UINB have similar analgesic effects after uniportal video-assisted lobectomy. However, TINB demonstrates shorter surgical time and a higher success rate than UINB.