Background: In the realm of thoracic surgery, video-assisted thoracoscopic surgery (VATS) is a well-established minimally invasive approach. The objective of the current study is to compare the analgesic effects of erector spinae plane blocks guided by ultrasound vs serratus anterior plane blocks guided by ultrasound in patients undergoing thoracoscopic sympathectomy for palmer hyperhidrosis. Patients and methods: A total of 110 patients, aged between 21 and 40 years old planed for sympathectomy, were randomly allocated into 55 patients who were subjected to erector spinae plane block (ESPB) and 55 patients who were subjected to serratus anterior plane block (SAPB). All patients with VAS more than 30 were received i.v. ketorolac 30 mg every 8 hours. Up to the end of the first 24 hours following surgery, the total amount of fentanyl and paracetamol used was tracked, along with the length of analgesia, the occurrence of side effects during the first 24 hours following surgery, and the patient satisfaction score after 12 and 24 hours. Result: The total analgesic (fentanyl) consumption in 24 h was significantly lower in ESPB group compared with SAPB group. Significantly lower VAS was observed with ESPB. Significantly longer time for the first request to rescue analgesia was recorded with ESPB. Significantly longer time of block performance was observed in ESPB group. Significantly delayed onset of sensory block and less number of fentanyle doses were recorded in ESPB group. No significant difference between ESPB and SAPB as regards to patient satisfaction score and side effects. Conclusion: ESPB shows superior analgesic effect to SAPB in sympathectomy surgeries