Prone Extubation for Awake Intraoperative Paraesthesia Mapping During Spinal Cord Stimulator Paddle Lead Implantation

Spinal cord stimulation (SCS) is an established treatment for refractory neuropathic pain. Trial SCS implantation often requires active patient participation for intraoperative paraesthesia mapping, creating unique anesthetic challenges, particularly in the prone position. We report the case of a 28-year-old female undergoing trial paddle lead implantation at D8–D10. Following laminotomy and lead placement, complete neuromuscular reversal was achieved with intravenous sugammadex, and the patient was extubated in the prone position while the surgical wound remained open. Under dexmedetomidine sedation and effective local analgesia, she remained comfortable, cooperative, and responsive, allowing successful intraoperative paraesthesia mapping. Following confirmation of optimal lead placement, sedation was continued and the procedure was completed without further airway intervention. The patient experienced 95% pain relief during the trial and subsequently underwent permanent SCS implantation 1 week later. This case highlights an individualized anesthetic strategy that facilitated safe awake neurological assessment while maintaining airway safety in a challenging prone position.