PURPOSE: To investigate postoperative pain variations in vitreoretinal surgeries conducted with combined regional-general anesthesia or general anesthesia. DESIGN: Systematic review and meta-analysis. METHODS: A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted to identify relevant randomized controlled trials published before December 26, 2023. Studies comparing vitreoretinal surgeries conducted under combined anesthesia to general anesthesia were included, while studies using only regional anesthesia were excluded. The quality of the studies was assessed using the Cochrane Collaboration risk of bias tool, and the results are presented as odds ratios or standardized mean differences (SMDs) with 95% confidence intervals (CIs). I RESULTS: A total of 19 randomized controlled trials involving 1314 patients were analyzed. Combined anesthesia was associated with lower proportions of patients needing as-needed postoperative analgesics (odds ratio, 0.218 95% CI, 0.114-0.418, I CONCLUSIONS: Combined anesthesia demonstrated additional postoperative analgesic effects versus general anesthesia only. Further research is needed to validate the results of our study and to identify vision-threatening complications.