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Background and Aims Postoperative pain management in breast oncologic surgery is a crucial issue for improving patient recovery. This study aims to compare the effectiveness of the paravertebral block (PVB) and the erector spinae plane block (ESP) in controlling acute and chronic postoperative pain, as well as their impact on patient satisfaction, opioid analgesic consumption, and hospital length of stay.Methods We conducted a double-blind, randomized trial involving 264 patients undergoing oncologic breast surgery for breast cancer. Patients were divided into two groups of 132, receiving either a PVB or an ESP for regional anesthesia. Evaluated parameters included acute postoperative pain measured by the visual analog scale (VAS), morphine consumption, patient satisfaction, length of hospital stay, and the incidence of chronic pain assessed.Results The results show that PVB and ESP are similar in controlling acute postoperative pain, with no significant difference in morphine consumption or patient satisfaction. However, ESP demonstrated greater effectiveness in preventing chronic pain compared to PVB (p value 0.041), with a lower incidence; No significant difference was observed regarding the length of hospital stay between the two groups.Conclusions While both the paravertebral block (PVB) and the erector spinae plane block (ESP) provide comparable results for managing acute pain after oncologic breast surgery, the ESP stands out for its better management of chronic pain. Further studies are needed to understand the mechanism of action of these blocks and to refine clinical recommendations for long-term postoperative pain management in this context.