Background: This study aimed to compare the safety, efficacy, and postoperative outcomes of inguinal hernia repair under ultrasound-guided local anaesthesia versus spinal anaesthesia. Methods: A prospective analysis was conducted on 50 patients undergoing inguinal hernia repair, divided into two groups: Group A (local anaesthesia) and Group B (spinal anaesthesia). Demographic characteristics, intraoperative parameters, pain perception, and postoperative complications were evaluated. Result: The mean age of patients in Group A was 46.12 ± 15.26 years, and in Group B, 42.72 ± 14.25 years (p = 0.420). Surgical duration was significantly shorter in Group A (40.32 ± 10.015 minutes) compared to Group B (61.52 ± 14.344 minutes) (p < 0.001). Group A experienced lower pain intraoperatively and postoperatively. At 12 and 24 hours, Group B had higher VAS scores (p = 0.004, p = 0.022, respectively). Postoperative urinary retention was significantly higher in Group B (p = 0.001). Conclusion: Local anaesthesia offers shorter surgical time, reduced postoperative pain, and fewer complications compared to spinal anaesthesia in inguinal hernia repair.