Objective To investigate the effects of bilateral paravertebral block (PVB) at the T12 on pain and adverse effects after uterine artery embolization (UAE). Design Prospective, double-blind, and randomized-controlled study. Setting Second Affiliated Hospital of Soochow University. Population Forty patients undergoing UAE for the treatment of symptomatic fibroids. Methods Patients scheduled for UAE were randomly assigned to receive either a bilateral PVB at T12 with 20 ml 0.375% ropivacaine or a simulated block. The multimodal analgesia protocol for all patients included systematic administration of flurbiprofen axetil, phloroglucinol, and a sufentanil intravenous patient-controlled analgesia. Main outcome measures The primary outcome was the intravenous cumulative sufentanil consumption within the first 24 h postoperatively. Secondary outcomes included numerical rating scale pain scores at 0, 1, 2, 4, 6 and 24 h postoperatively and so on. Results Thirty-six patients were analyzed per the established scheme (four patients were dropped because of the discontinuous use of patient-controlled analgesia). The 24-h total sufentanil consumption was statistically lower in the PVB group compared with the control group (30 [25 to 34] versus 40 [34 to 44] μg; median difference, -10; 95%CI, -16 to -6; P < 0.001). The PVB group had a lower maximal numerical rating scale within 24 h postoperatively (3.4 [±1.2] versus 6.1 [±1.9]; mean difference, 2.7; 95% CI, 1.7 to 3.8; P < 0.001). Conclusions T12 PVB in conjunction with multimodal analgesia provides effective perioperative pain alleviation and reduces the consumption of pain-related opioids after UAE. Funding No funding was obtained for this study.