A retrospective study of 508 open surgical PD catheter implantations between 2010–2021 compared general anesthesia (GA, 419 cases) with local/regional (LA, 89 cases). Patients in the LA group were older and more comorbid, with 49.4% classified as ASA ≥ 4 versus 14.6% in GA. LA was associated with shorter times in the operating room, after anesthesia, and faster transfer to care units. The rate of postoperative surgical complications was comparable in both groups. Prolonged intensive treatment occurred more often in patients with LA. In patients with ASA ≥ 4, LA showed a trend towards lower intraoperative use of catecholamines (47.7% vs. 67.2%; p=0.0697). After adjustment for age, ASA score, and comorbidities, anesthetic strategy was not independently associated with the main safety outcomes, with LA allowing more efficient use of resources, especially in isolation.