Background <p>The ultrasound-guided thoracic paravertebral nerve block (TPVB) is widely used in video-assisted thoracoscopic surgery (VATS). However, the impact of ultrasound-guided TPVB on the postoperative quality of recovery (QoR) remains unclear in patients undergoing VATS. The objective of this systematic review and meta-analysis was to explore the impact of ultrasound-guided TPVB on postoperative QoR score after VATS in comparison to the control group without receiving either TPVB or other blocks.</p> Methods <p>The Cochrane Library, Embase, PubMed, Web of Science, CNKI, WanFang, and CBM databases were searched for randomized controlled trials (RCTs) that evaluated the impact of ultrasound-guided TPVB versus no TPVB or other blocks on postoperative QoR after VATS from inception to January 2025. Two independent researchers carried out the screening of records, the inclusion of full-text studies, and the extraction of data. The outcomes were evaluated using random-effects or fixed-effects meta-analyses.</p> Results <p>Seven articles involving 890 participants published from 2016 to 2022 were identified. Our results indicated that ultrasound-guided TPVB could enhance postoperative QoR score (MD = 10.48, 95% CI [5.33 to 15.64]), decrease VAS score (MD =  − 1.57, 95% CI [− 2.30 to − 0.85]), diminish the incidence of PONV (OR = 0.20, 95% CI [0.08 to 0.51]), shorten the time to extubation (MD =  − 8.71, 95% CI [− 15.47 to − 1.94]), and the duration of hospitalization (MD =  − 0.92, 95% CI [− 1.72 to − 0.11]) after VATS.</p> Conclusions <p>This meta-analysis revealed that ultrasound-guided TPVB might improve the quality of recovery after VATS. Our results also showed that ultrasound-guided TPVB could reduce postoperative pain, incidence of PONV, extubation time, and the length of hospital stay.</p>