Anesthesia considerations and postoperative pain management in awake spine surgery

Awake spine surgery is a viable alternative to general anesthesia for select lumbar procedures, including decompressions and fusions. The combined use of spinal anesthesia and targeted regional nerve blocks allows operations to be performed under moderate sedation while preserving patient comfort, hemodynamic stability, and airway safety. This approach reduces postoperative pain, shortens hospital stays, and lowers perioperative complications. 1 , 2 , 3 Building on existing enhanced recovery principles, MedStar Georgetown University Hospital has developed a structured protocol emphasizing preoperative analgesia, intraoperative stability, and postoperative pain management. This manuscript outlines patient selection, anesthetic considerations, and a stepwise perioperative methodology to optimize safety and recovery.