One hundred three patients with L5/S1 disc herniation were randomized to receive local anesthesia with 1% lidocaine (n=53) or general anesthesia (n=50) during PEID. The primary outcomes were operative parameters including operative time, blood loss, and bed rest duration. Secondary outcomes included VAS, ODI, modified MacNab criteria, hospitalization cost, complications, and satisfaction. Outcomes were assessed at 1 day, 3 months, 6 months, 1 year, and 2 years. Overall, results showed that local anesthesia significantly reduced operative time (62.2 vs 90.6 min, P<0.0001), bed rest time (4.2 vs 12.6 h, P<0.0001), and cost, although blood loss was greater (76.6 vs 45.4 mL, P<0.0001). Pain, disability, and functional outcomes were similar between groups at all follow-ups. Postoperative neuropathic symptoms were less frequent with local anesthesia (1.9% vs 8.0%, P<0.001). These findings suggest that local anesthesia is a safe, effective, and cost-efficient alternative to general anesthesia for PEID.