Abstract: Objective To observe the efficacy and safety of total intravenous anesthesia combined with continuous erector spinae plane block in patients with thoracoscopic surgery with retained breathing and non-intubation. Methods A total of 60 patients undergoing thoracoscopic surgery in our hospital were selected, and were randomly divided into total intravenous anesthesia group(T group), and intravenous anesthesia combined with ESP block and breathing retention group(ESP group). The general situation of the two groups were recorded. Norepinephrine, adrenaline and cortisol levels were measured before anesthesia induction(T₀), after operation(T₁), at 30 min after operation(T₂), before extubation(T₃)and at 12 h after operation(T₄). The hemodynamic indicators such as mean arterial pressure(MAP)and heart rate(HR)at T₀, T₁, T₂, T₃ of two groups were compared. The Visual Analogue Scale(VAS)pain scores at rest and exercise were recorded at different time points after operation, and the recovery time, hospitalization time and the incidence of adverse - events such as postoperative sore throat, nausea, vomiting were recorded. Results Compared with T₀, the levels of norepinephrine, epinephrine and cortisol in both groups were increased at time points of T₁, T₂, T₃, T₄, but were lower in ESP group than those in T group at the same time points. The recovery time and hospitalization time in ESP group were shorter, and resting VAS pain score within 24 hours after operation and exercise VAS score within 48 hours were lower than those in T group(P < 0.05). The MAP, HR at T_1~3 in ESP group was more stable than that in T group(P < 0.05), and the incidence of sore throat, nausea and vomiting was significantly decreased at T_1~3 (P < 0.05). Conclusion Intravenous anesthesia combined with continuous erector spinae plane block is feasible in non-intubation thoracoscopic surgery, which has the features of stable hemodynamics, lower perioperative stress response, and less postoperative complications, and is conductive to the early rehabilitation.