Introduction: To evaluate the efficiency and safety of the paravertebral block (PVB) as the single main anesthesia for unilateral mini-invasive percutaneous nephrolithotomy (PCNL). Materials and Methods: Forty-five American Society of Anesthesiologists grade I/II/III patients with large upper urinary tract stones were included in our retrospective study. All patients received multilevel PVB from T10 to L1 with 10 mL of 0.5% ropivacaine for each segment. After the block was confirmed, unilateral mini-invasive PCNL was performed. Intraoperative and postoperative pain management and associated adverse events were observed to investigate the feasibility of PVB in mini-invasive PCNL as the main anesthesia. Results: Successful blocking was confirmed 20 min after paravertebral injections. The mean operation time was 59 min. None of the patients experienced severe pain or hemodynamic dysfunction. Stone-free rate was 93.1% and no blood transfusion was required. The mean time to first analgesic requirement was 160 min, and the mean consumption of diclofenac sodium suppositories was 150 mg. All patients contained normal muscle strength on the contralateral side. Patients could recover ambulation within 1 h after the operation. Conclusions: Multilevel PVB was proved to be suitable as the main anesthesia for unilateral mini-invasive PCNL, providing feasible pain relief and quick postoperative recovery. (C) 2017 S. Karger AG, Basel