Objective To evaluate the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with target-controlled infusion (TCI) of remifentanil in extracorporeal shock wave lithotripsy (ESWL) of pancreatic stones. Methods Sixty patients with pancreatic stones who received ESWL for the first time were randomly divided into R group and TR group (30 cases in each group). Patients in R group received TCI of remifentanil only, while patients in TR group received ultrasound-guided TAPB 30 min before TCI of remifentanil. Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC₅₀) of remifentanil. Perioperativevisual analog scale (VAS), Ramsay sedation scale, hemodynamic parameters, respiratory parameters, and adverse events were also recorded. Results The EC₅₀ of remifentanil were 3.448 ng/mL (95% confidence interval[CI] 1.636-3.946 ng/mL) and 2.523 ng/mL (95% CI 0.744-2.991 ng/mL) in the R group and the TR group, respectively (P<0.05). The VAS score and the Ramsay sedation scale were comparable between the two groups (both P>0.05), and there were no significant differences in hemodynamics and respiratory parameters between the two groups (both P>0.05). Compared with the R group, the total incidence rate of adverse events was lower in the TR group (10.0%[3/30]vs 56.7%[17/30], P<0.001), and so was the incidence rate of itching (6.7%[2/30]vs 26.7%[8/30], P=0.038). Conclusion TAPB combined with TCI of remifentanil can provide satisfactory analgesia and sedation for ESWL of pancreatic stones, and can reduce the dosage of remifentanil, with less adverse events.