This study aimed to report the use of a multimodal anesthetic (MA) regimen by combining a panoply of drugs without opioids for posterior spinal fusion surgery in a patient with Low-back incapacity and opioid intolerance. The surgery occurred without incidents nor do hemodynamic instabilities, except for a delay in waking up, reverse with extra doses of decurarizing. On the 13th day, she reported mild pain (VAS 2/10) and was satisfied with the result of the surgery. This case report highlights the new concept of using manifold drugs through the use a goal- direct strategies based on monitoring. Furthermore, we emphasize the use of good monitoring, such as ANI and IGP, for the success of this type of surgery.