Background: Developing a scientific and effective anesthesia analepsia management strategy is of great significance to reduce the risk of complications in elderly patients. This study aims to explore the effect of analepsia management on the postoperative stress reaction and oxygenation in elderly patients with lumbar spine surgery.Methods: In this randomized controlled study, 60 elderly patients who underwent lumbar spine surgery with general anesthesia in Traditional Chinese Medicine Hospital of Shapingba District, Chongqing City were included. According to the random number table method, patients were randomly divided into test group (n=30) and control group (n=30). During the analepsia period, patients in the control group received routine management, while the test group received a new analepsia management strategy based on the control group. The analepsia quality, postoperative stress reaction, oxygenation function, and complication rates of the two groups were compared.Results: Compared with the control group, the extubation time, fully awake time, and resuscitation chamber residence time in test group were significantly shortened (P<0.05). At different times postoperatively, the test group had significantly lower epinephrine, cortisol, and blood sugar levels than the control group (P<0.001), and significantly higher or lower PaO2, oxygenation index (OI), and PaCO2 values (P<0.01). Compared with the control group, the postoperative visual analogue scale (VAS) score in the test group was lower (P<0.05), while the Quality of Recovery-40 (QoR-40) score was higher (P<0.05), and the test group had a lower incidence of restlessness, hypothermia and respiratory complications during the analepsia period (P<0.05).Conclusions: This study showed that the analepsia management strategy could improve the postoperative stress reaction and oxygenation function of elderly patients with lumbar spine surgery, which could promote the postoperative recovery of patients.