Background: Breast surgery is a common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Objective: To compare the difference between the anesthetic effect of thoracic epidural versus serratus anterior plane block in breast surgery. Patients and methods: This study conducted on 60 adult patients scheduled for elective breast surgery divided into three groups. Each group contains twenty patients. Group A (n. 20) received general anesthesia only, Group B (n. 20) received combined general anesthesia and thoracic epidural analgesia, by receiving 6–8 ml of 0.25% bupivacaine and 0.05 mg fentanyl via the epidural catheter and Group C (n. 20) received serratus anterior plane block combined with general anesthesia. Results: The results of the present study demonstrated that SAP block caused hemodynamic stability, decreased the intensity of postoperative pain, reduced postoperative analgesic requirement, prolonged the time needed for the first request of analgesia, Therefore it can be considered as a safe procedure and effective for intraoperative and postoperative pain control in breast surgeries. Also, this study demonstrated that there is no difference between the groups according to nausea and vomiting. Conclusion: SAP block can produce excellent pain relief during the first six postoperative hours. It has a great promise due to its simplicity, easy-to-learn techniques, and relative lack of contraindications and complications.