Purpose Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH. Methods Sixty patients were randomly assigned to receive either PVB or GA under standardized protocols (group PVB: at T 9 –L 1 levels, 5 mL of 0.5% levobupivacaine for both procedures, and continuous propofol sedation; group GA: GA with 2 mg kg −1 propofol induction and 2–4% desflurane maintenance via LMA, and routine antiemetic prophylaxis and multimodal analgesic treatment). Anesthesia-related, onset, recovery, and home discharge times, hemodynamic changes, pain, and incidence of adverse effects were compared. Results Anesthesia-related time and onset time were longer, but recovery and home discharge times were shorter in group PVB. Verbal rating scores (VRS) at 30, 60, 120, and 180 min and 6, and 12 h post-surgery were significantly lower in group PVB patients. VRS at 18, 24, and 48 h were comparable in both groups. No patient in group PVB and eight patients in group GA needed meperidine in the post-anesthesia care unit, and time to first analgesic and first rescue analgesic requirements were significantly longer in group PVB. Conclusion In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.