Objective The aim of this study was to explore the potential influence of time sequence （before or after sugery） of thoracic paravertebral nerve block （TPVB） on the body temperature of elderly patients during recovery. Methods Patients in postanesthesia care unit （PACU） between January 2023 and October 2024 in Tongzhou district of Peking University People′s Hospital were retrospectively collected. Inclusion criteria were as follows： （1） patients aged more than 60 years； （2） those preformed thoracoscopic lung surgery under general anesthesia； （3） American Society of Anesthesiologists （ASA） Physical Status of patients was Ⅰ to Ⅲ； （4） those received TPVB for analgesia. All the patients were divided into two groups： preoperative TPVB group （pre-TPVB group） and postoperative TPVB group （post-TPVB group）. The demographic and anesthesia- and surgery-related data of patients were collected. The body temperature， incidence of hypothermia， numerical rating scale （NRS） score， extubation time， the length of stay and the occurrence of hypotension， chill and delayed awakening in PACU were compared between the two groups. Results After excluded 4 patients from 538 patients enrolled， a total of 534 patients were eligible， with 406 cases in pre-TPVB group and 128 cases in post-TPVB group， respectively. The results showed that the body temperature was significantly higher in pre-TPVB group ［36.1（36.0，36.2）℃ vs. 36.0（35.9，36.2）℃， P = 0.022］， and the incidence of hypothermia was lower in pre-TPVB group （18% vs. 29.7%， P = 0.007）. And the pre-TPVB group were higher in NRS scores ［0（0，0） vs. 0（0，0）， mean rank： 248.38 vs. 270.95， P = 0.036］ and shorter in the length of stay in PACU ［44（38，53）min vs. 48（40，55）min， P = 0.039］. Conclusion Preoperative TPVB offers more benefits for body temperature protection and shortening the length of stay in PACU in elderly patients undergoing thoracoscopic lung surgery， but it slightly offset the analgesic efficacy in the PACU.