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Background and Aims Heart rate variability (HRV) serves as a sensitive indicator of the autonomic nervous system, which is influenced by anesthesia and surgical stimulation. Adequate regional anesthesia is hypothesized to modulate the autonomic nervous system response during surgery. This study aimed to evaluate the impact of neuraxial techniques and interfascial blocks on HRV dynamics in comparison to general anesthesia during hernioplasty.Methods The study enrolled 91 patients undergoing surgical repair of anterior abdominal wall hernias. Patients were allocated into three groups: general anesthesia (n=31), neuraxial techniques (n=30), and interfascial blocks (n=30). HRV parameters were recorded throughout the surgical procedure, and their dynamics were visualized relative to the baseline level (100%).Results In the general anesthesia group, a progressive decrease in the sympathovagal balance (LF/HF ratio) was observed throughout the surgery, reaching 67.3% of the baseline value at the end. In contrast, the neuraxial techniques group exhibited a 1.6-fold increase in LF/HF at the midpoint of surgery and maintained 115.5% of the baseline level at the end. The interfascial blocks group also showed an increase in LF/HF to 127.9% of the baseline value at the end of surgery. Notably, the general anesthesia group demonstrated a significant reduction in both low-frequency and high-frequency HRV indices.Conclusions Regional anesthesia techniques, both neuraxial and interfascial blocks, demonstrated a distinct impact on HRV dynamics during hernioplasty compared to general anesthesia. They facilitated the preservation or even augmentation of the sympathovagal balance at the end of surgery, which may suggest better autonomic nervous system control and less suppression of parasympathetic activity compared to general anesthesia.