P009 Spinal anesthesia for awake spine surgery: a paradigm shift illustrated by a complex case

<h3>Background and Aims</h3> Awake spine surgery using regional anesthesia has emerged as a viable alternative to general anesthesia, driven by the growing need to manage an increasingly elderly and high-risk surgical population. This approach is associated with reduced perioperative complications, earlier mobilization, and decreased opioid requirements. We aim to demonstrate the feasibility, safety, and clinical benefits of awake spine surgery through the management of a high-risk patient. <h3>Methods</h3> We present a case of an 80-year-old male with severe ischemic heart disease (left ventricular ejection fraction 34%), chronic obstructive pulmonary disease, and metastatic pulmonary adenocarcinoma causing sacral spinal cord compression. The patient was scheduled for lesion excision, laminectomy, and decompression under continuous spinal anesthesia. A continuous subarachnoid block was performed using an initial dose of 3 mg levobupivacaine 0.5% combined with 2.5 mcg sufentanil, followed by supplementary doses of 2 + 1 mg levobupivacaine. Light sedation was maintained with target-controlled infusion (TCI) of propofol, and analgesia was complemented with 2 g of metamizole. <h3>Results</h3> The surgery was successfully completed under regional anesthesia without the need for conversion to general anesthesia. Intraoperative hemodynamic parameters remained stable, with no significant hypotensive or hypoxic events. Postoperatively, the patient developed mild, transient respiratory depression, managed conservatively without escalation of care. He achieved early mobilization within 24 hours and was discharged without major complications. <h3>Conclusions</h3> Spinal anesthesia for awake spine surgery provides a safe and effective anesthetic alternative for high-risk patients who are poor candidates for general anesthesia. This case highlights the potential of awake spine surgery to enable successful surgical intervention while minimizing perioperative risks in fragile populations.