This review summarizes the intraoperative anesthesia protocols for radiofrequency thermal coagulation in the treatment of trigeminal neuralgia, focusing on the advantages and disadvantages of two primary anesthesia approaches. The first approach involves the injection of local anesthetics, such as lidocaine, at the radiofrequency target, which can alleviate pain during the procedure but carries potential risks. The second approach discusses the efficacy of intravenous administration of propofol for pain control, highlighting the necessity for vigilant monitoring of vital signs during the procedure. This article aims to provide the latest evidence-based guidance for anesthesia protocol selection in clinical practice.