The study analyzed the safety and efficacy of paravertebral block with dezocine and ropivacaine in 192 patients with non-small cell lung cancer undergoing video-assisted thoracoscopic surgery (VATS). Patients were randomly assigned to a low-dose (L: 0.1 mg⋅kg⁻¹ dezocine + 0.375% ropivacaine, n=96) and a high-dose (H: 0.15 mg⋅kg⁻¹ dezocine + 0.375% ropivacaine, n=96) group. Group L achieved faster respiratory recovery, awakening, and extubation (all P < 0.001). Group H required less analgesics within 12 hours (16.67% vs. 46.88%, P < 0.001) and had lower pain scores (VAS) in both resting and active states at 1, 6, 12, and 24 hours (all P < 0.05). Both groups had a transient increase in the inflammatory markers CRP, TNF-α, and PCT at 24 h, followed by a decrease (all P < 0.01). The incidence of adverse events did not differ (6.25% vs. 8.33%, P > 0.05). The higher dose of dezocin provided better postoperative analgesia and suppression of inflammation with high safety of both doses.