The aim of this meta-analysis is to systematically evaluate the clinical effects of local anesthesia and spinal anesthesia in the treatment of open inguinal hernia in adults, and provide theoretical evidence for clinical choice.We searched the PubMed, Embase and The Cochrane Library, and collected published clinical randomized controlled trials (RCTs) on the efficacy and safety of local anesthesia and spinal anesthesia for open inguinal hernia surgery in adults. According to the inclusion and exclusion criteria, the literature was screened and the data was analyzed by using Review Manager.A total of 11 RCT studies were included in the meta-analysis, with 591 cases in the local anesthesia group and 584 cases in the spinal anesthesia group. Our results showed that compared with the spinal hernia repair group, the hernia repair group under local anesthesia had a lower incidence of headache (RR=0.11, 95% CI: 0.03, 0.46), urinary retention (RR=0.13, 95% CI: 0.05, 0.32) and postoperative pain score at 12 hours (SMD=-1.09, 95% CI: -1.41, -0.76), and a higher anesthesia efficiency (RR=1.09, 95% CI: 1.03, 1.16) and satisfaction rate (RR=1.12, 95% CI: 1.01, 1.24). There was no statistically significant difference between the two groups in operation time, the incidence of intraoperative pain, hematoma, infection, postoperative chronic pain in the groin area, and testicular pain/swelling.In open inguinal hernia surgery for adults, local anesthesia is better than spinal anesthesia with lower incidence of adverse events, higher efficacy and satisfaction.