Objective To observe the efficacy and safety of Hydromorphone combined with Ropivacaine for patient controlled epidural analgesia (PCEA) after thoracoscopic-laparoscopic radical esophagectomy.Methods 60 patients scheduled for thoracoscopic-laparoscopic radical esophagectomy were randomly divided into two groups, Hydromorphone combined with Ropivacaine for PCEA group (group H, n = 30) and Sulfentanyl combined with Ropivacaine for PCEA group (group S, n = 30). Surgery was performed under combined general anesthesia and epidural anesthesia, and PCEA was given after surgery with different analgesia pump formula: Hydromorphone 10 μg/mL + Ropivacaine 1.25 mg/mL for group H and 0.3 μg/mL Sulfentanyl + 1.25 mg/mL Ropivacaine for group S. Dosage regimen: loading does was 6 mL, background infusion was 4 mL/h, bolus volume 5 mL, and lockout interval 30 minutes. The VAS scores at rest, on coughing and modified Bromage degrees were recorded at 4, 8, 12, 24 and 48 h after surgery. The effective pressing times (D1), the actual pressing times (D2), the effective/actual pressing times ratio (D1/D2) and patient satisfaction with analgesia were recorded within 48 h after surgery. The side effects and the remedial analgesia situation were documented and used to calculate the analgesic remedy frequency within 48 h after surgery.Results Compared with group S, the VAS scores at rest and on coughing at 4, 8, 12, 24 and 48 h after surgery in group H were significantly lower than those in group S (P < 0.05); D1, D2 and analgesic remedy frequency within 48 h after surgery in group H were significantly lower than those in group S (P < 0.05); D1/D2 and patient satisfaction with analgesia in group H were significantly higher than those in group S (P < 0.05). There was no significant difference between the two groups in the modified Bromage grade at 4, 8, 12, 24 and 48 h postoperatively and the incidence of adverse reactions within 48 h postoperatively (P > 0.05).Conclusion Administration of Hydromorphone combined with Ropivacaine for PCEA after thoracoscopic-laparoscopic radical esophagectomy provided definite analgesic efficacy and few side effects. Compared with Sulfentanyl combined with Ropivacaine for PCEA, Hydromorphone combined with Ropivacaine for PCEA had better analgesic effect and improved patient satisfaction.