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The present study aimed to assess the efficacy and safety of thoracic paravertebral regional anesthesia (TPVBRA) in patients with breast cancer surgery.In total, 72 patients undergoing breast cancer surgery were randomly divided into an intervention group and a control group; each group contained 36 subjects. Both groups received TPVBRA with 20 mL 0.25% bupivacaine. In addition, subjects in the intervention group also received an additional 1 μg/kg dexmedetomidine. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pain intensity (measured by visual analogue scale, VAS), and analgesic consumption were assessed; adverse events were also recorded.Significant differences were observed in HR (P < .05), SBP (P < .05), and DBP (P < .05) at the 30-minute point during surgery between the 2 groups. In addition, the time of the first administration of analgesia (P = .043) and the mean consumption of analgesic agents (P = .035) in the intervention group were much better than those in the control group. However, no significant differences in HR or VAS were found at any time point after surgery (P > .05). Furthermore, similar adverse events were detected in both groups (P > .05).The results of this study showed that TPVBRA combined with bupivacaine and dexmedetomidine can enhance the duration and quality of analgesia without serious adverse events.