Purpose of Review <p>The population of complex spine surgery patients continues to expand. Despite the application of multiple perioperative strategies, postoperative pain is a significant problem for the spine patient population. This review presents and increases awareness of new interventions, including methadone and regional anesthetic techniques, to improve the perioperative management of patients undergoing complex spine surgeries.</p> Recent Findings <p>Erector spinae plane (ESP) block is a safe, simple, and novel technique that should be considered in spine patients for opioid-sparing analgesia. Local anesthetic adjuvants that have been used to prolong the analgesic duration of regional blocks can be used during the ESP block.</p> Summary <p>Instead of intermittent administration of shorter-acting opioids like hydromorphone, methadone should be considered for longer and less uneven periods of pain control. Regional block techniques like ESP and Thoracolumbar interfascial plane (TLIP) blocks can provide high-quality analgesia. Randomized trials in larger patient populations are needed to provide better data on these interventions.</p>