Objective To observe the feasibility, superiority and safety of electroacupuncture combined with erector spinae plane block for non‑intubated anesthesia in thoracoscopic surgery. Methods A total of 40 patients who were scheduled for thoracoscopic surgery from March 2020 and September 2021 were enrolled. According to the random number table method, they were divided into two groups (n=20): an electroacupuncture combined with erector spine plane block group (group A) and an erector spine plane block group (group B). Both groups were subjected to erector spinae plane block. Group A was stimulated by electroacupuncture throughout the whole process, while group B was subjected to transcutaneous electroacupuncture without electric stimulation. The operation type, operation time, and anesthesia time were recorded; the dosages of dexmedetomidine, remifentanil (10 times of sufentanil dose was converted into the equivalent dose of remifentanil), and cardiovascular agents were recorded. The arterial partial pressure of carbon dioxide (PaCO2) before operation, before skin incision, 1 h after operation and the maximum values during operation were recorded. The Visual Analogue Scale (VAS) scores at postoperative 1 h and 24 h and the number of cases of remedial analgesia within 24 h after operation was recorded. The counts of white blood cells (WBC) and neutrophils (NEU) before operation and the difference from the first day after operation were recorded. The length of postoperative hospitalization stay, as well as adverse reactions such as nausea, vomiting, dizziness, and agitation were recorded. Results Compared with group B, the amount of remifentanil significantly decreased in group A and the maximum intraoperative PaCO2 was significantly reduced (P<0.05). There were no statistical differences in the type of surgery, operation time, anesthesia time, dexmedetomidine dose, the use of intraoperative cardiovascular medications, PaCO2 (before operation, before skin resection, and at postoperative 1 h), the VAS score (at postoperative 1 h and 24 h), the number of cases of remedial analgesia within 24 h after operation, and the length of postoperative hospitalization stay, and the incidence of adverse events between the two groups (P>0.05). There was no statistical difference in the counts of WBC and NEU before operation and the difference from the first day after operation (P>0.05). Conclusions Electroacupuncture combined with erector spinae plane block for non‑intubated anesthesia in thoracoscopic surgery can reduce the intraoperative dosage of remifentanil, with less increases in intraoperative PaCO2, and more smooth breathing.