Ovarian cysts is one of the most common gynaecology benign tumour found in women in their reproductive years. Ovarian cysts consist of fluid-filled pockets such as water-filled balloons in the ovaries. Permagna ovarian cyst is a cyst with a diameter exceeding 10 cm. Clinical manifestations that occur can include abdominal discomfort, difficulty urinating, pelvic pain, and pain during intercourse and menstrual disorders. Medical management that can be performed in patients with ovarian cysts is by hormonal and surgical treatment. Through surgery, management of ovarian cysts can be done with laparotomy or laparoscopy. Laparoscopy surgery of ovarian cysts requires anesthesia. It is known that laparoscopy procedures are usually performed under general anesthesia due to respiratory changes caused by pneumoperitoneum. However, the use of spinal anesthesia has emerged as an alternative choice for laparoscopy because of its safe use. Anesthesia management was reported in 22 years old patient with Permagna Ovarian Cyst who performed laparoscopic surgery. Anesthesia technique with spinal anesthesia using bupivacaine hcl 0.5% 20 mg added pethidine 25 mg. During operation, patient was sedated with midazolam 2.5-5 mg intravenous, hemodynamic was stable and patient also comfortable until operation finished.