Objective: to evaluate the safety, efficacy, feasibility of mini-percutaneous nephrolithotomy (MPCNL) under mixture of local anesthetics (MLA) versus spinal anesthesia (SA)for management of renal stones. Patients and methods: the current study was a prospective randomized controlled study. In all, 120 consecutive patients with nephrolithiasis >2 cm were randomized to undergo MPCNL under LA (60 patients) or SA (60 patients). Intra and post-operative findings included visual pain analogue scale (VAS), operative time, hospital stay, adverse events, stone free rate and related data were recorded. Results: Baseline characteristics and demography were comparable for both groups. The average VAS score at 0, 6, 12 hours was 2.5, 1, 1 vs 2, 2, 2 (p< 0.05) respectively. While it was 1, 0 vs 0, 0 at 2 & 24 hours, respectively. Operation time was about an hour, the hospital stay was 1.5 days for both groups (p> 0.05), mean hemoglobin deficit was 1.04±0.54 % vs 1.27±0.46 (p=0.013), stone clearance was 93.4%, and 88.3% (p > 0.05) respectively. Post-operative analgesic consumption and Complications were similar between both groups. Conclusion: MPCNL is feasible under either mixture of Local or Spinal anesthesia with comparable stone clearance & adverse events. Perioperative VAS was similar and acceptable for both modalities.