Thoracic paravertebral block (TPVB) is a regional anaesthesia technique that injects local anaesthetic into the thoracic paravertebral space (TPVS), providing unilateral somatic and sympathetic blockade. It is widely used for analgesia in thoracic and upper abdominal surgeries, including mastectomy, thoracotomy, rib fractures, and chronic chest wall pain management. TPVB targets thoracic spinal nerves and sympathetic ganglia, making it an effective alternative to epidural anaesthesia with fewer haemodynamic complications. Three primary approaches are used to perform TPVB: landmark-based, ultrasound-assisted, and ultrasound-guided techniques. The ultrasound-guided approach enhances precision and safety by allowing real-time visualisation of anatomical structures, reducing the risk of complications such as pneumothorax, vascular puncture, and local anaesthetic toxicity. Continuous TPVB techniques involving catheter placement are preferred for prolonged post-operative analgesia, particularly in procedures like nephrectomy and mastectomy. While TPVB provides superior visceral analgesia, newer interfascial plane blocks such as erector spinae and serratus anterior plane blocks are emerging as safer alternatives with fewer complications. Despite its effectiveness, TPVB carries risks, including epidural spread, hypotension, and intercostal nerve injury, requiring careful patient selection and monitoring.