Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. The choice of anesthesia plays a significant role in perioperative safety, postoperative recovery, and patient comfort. Local anesthesia and spinal anesthesia are widely used for open inguinal hernia repair, yet their comparative outcomes remain a subject of clinical interest. Methods: This prospective comparative observational study was conducted in the Department of General Surgery at a tertiary care teaching hospital. A total of 96 adult patients with unilateral primary inguinal hernia were enrolled and equally divided into two groups: local anesthesia (n = 48) and spinal anesthesia (n = 48). All patients underwent tension-free Lichtenstein mesh hernioplasty. Results: Patients in the local anesthesia group demonstrated significantly lower postoperative pain scores, earlier ambulation, and shorter hospital stay compared to the spinal anesthesia group. Hemodynamic stability was superior in the local anesthesia group, while postoperative urinary retention was more common following spinal anesthesia. Surgical site complications were comparable between both groups. Conclusion: Local anesthesia is a safe, effective, and patient-friendly alternative to spinal anesthesia for open inguinal hernia repair. It offers superior postoperative recovery, early mobilization, and reduced hospital stay, making it particularly suitable for day-care surgery and resource-limited settings.