Abstract: Objective To compare and efficacy 0.2% ropivacaine epidural anesthesia versus 0.5% ropivacaine local infiltration anesthesia in percutaneous endoscopic lumbar discectomy (PELD) for treating lumbar disc herniation (LDH). Methods A prospective study enrolled 274 LDH patients undergoing PELD at 910 Hospital of Joint Logistics Support Force from January 2022 to January 2025. Patients were randomly assigned to the intervention group (n= 137) or the control group (n= 137) using a random number table. Patients in the control group received 0.5% ropivacaine local infiltration anesthesia, while patients in the intervention group received 0.2% ropivacaine epidural anesthesia. Anesthesia efficacy, clinical parameters, hemodynamics, postoperative pain, and adverse reactions were compared between the two groups. Results The rate of excellent/good anesthesia in the intervention group was significantly higher than that in the control group (P ＜ 0.05). There was no significant difference in the postoperative ambulation time between the two groups (P ＞ 0.05). The operation time was shorter, the total ropivacaine dosage was lower, and the recovery time was earlier in the intervention group compared to the control group (P ＜ 0.05). At 5 minutes after induction (T1), 30 minutes after pneumoperitoneum (T2), and 5 minutes after surgery (T3), there was no significant difference in blood oxygen saturation between the two groups（P ＞ 0.05）. However, the heart rate and mean arterial pressure in the intervention group were significantly lower than those in the control group at these time points (P ＜ 0.05). The visual analogue scale (VAS) scores at 6, 12 and 24 hours postoperatively in the intervention group were significantly lower than those in the control group (P ＜ 0.05). The VAS scores in both gradually decreased over time (P ＜ 0.05). The total incidence of adverse reactions in the intervention group was significantly lower than that in the control group (P ＜ 0.05). Conclusion 0.2% ropivacaine epidural anesthesia demonstrates significant advantages in PELD for LDH. It improves anesthesia efficacy and clinical indicators, provides more stable hemodynamics, reduces postoperative pain, and lowers the incidence of adverse reactions.