Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. The thoracic paravertebral block, following its rediscovery, is being used with increasing frequency and success for both surgery and recovery from thoracotomy, challenging the supremacy of thoracic epidural analgesia, which to date has been considered the gold standard. We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.