Despite the contention by some that local anesthesia is a preferred alternative to general anesthesia for laparoscopic sterilization, there have been no randomized studies comparing these techniques. To better characterize the relative safety and acceptability of these techniques for laparoscopic sterilization, we randomly assigned 100 women undergoing bipolar electrocoagulation or spring clip application to either local or general anesthesia. Of the 53 women assigned local anesthesia, four had their procedures completed using another technique because of technical problems related to obesity. Thirteen other obese women, however, underwent successful surgery with local anesthesia. Women undergoing local anesthesia had a slightly shorter anesthesia time (30 versus 36 minutes) and recovery room stay (65 versus 78 minutes). Women having general anesthesia were 2.3 and 1.5 times more likely to have maximum systolic and diastolic blood pressures above 160 and 90 mmHg, respectively. They were also 5.7 times more likely to have a maximum heart rate 110 or higher. Patient movement was reported to be a concern in five women undergoing general anesthesia, but in none having local anesthesia. An equal percentage (80%) of women in each group expressed satisfaction with their anesthetic technique.