Abstract: The present study evaluated the effects of lumbar epidural anesthesia (E) vs lumbar paravertebral block (P) and general anesthesia (G) with respect to intraoperative mean arterial blood pressure, heart rate, postoperative pain intensity, analgesic requirements and postoperative complications in patients undergoing percutaneous nephrolithotomy. The study included 57 patients undergoing percutaneous nephrolithotomy, patients were randomly allocated into three groups. Paravertebral group (P) (n = 18), Epidural group (E) (n = 19), General group (G) (n = 20), non invasive mean arterial blood pressure, intraoperative heart rate, the severity of postoperative pain for 24 h using (VAS), number of patients require analgesia, incidence of side effects: nausea, vomiting, urine retention were evaluated in all patients. Three patients were excluded from the study (2 in P group and 1 in E group) because of technical failure. Intraoperative mean arterial blood pressure was significantly lower in E group compared to P and G groups (p<0.05). Intraoperative heart rate shows no significant difference between P, E and G groups. The severity of postoperative pain were significantly less in P group compared to E and G groups (p<0.05), number of patients requiring postoperative analgesia was significantly lower in P group compared to E and G groups (p<0.05). Number of patients having postoperative nausea and vomiting was significantly higher in G group than in the P group and E group (p<0.05). Lumbar paravertebral block with bupivacain 0.5% was associated with more intraoperative hemodynamic stability, reduced postoperative pain and significantly decreased the postoperative analgesic requirements than epidural anesthesia and general anesthesia in patients undergoing percutaneous nephrolithotomy without increasing the incidence of PONV.