Objective To observe the effects of intraoperative awake anesthesia on the postoperative pain in patients undergoing craniotomy. Methods Patients undergoing intracranial tumor resection under asleep‑awake‑asleep protocol from October 2018 to June 2019 in Beijing Tiantan Hospital, Capital Medical University were consecutively selected and set as an awake group. Meanwhile, those undergoing intracranial tumor resection under general anesthesia were selected in which age, sex, surgical approach and surgery time were matched at a ratio of 1∶1 and set as a control group. The data of the two groups were collected from medical records, and their chronic pain 3 months after operation was followed up by telephone. The main outcomes were postoperative acute pain in postanesthesia care unit (PACU) and during hospitalization stay and postoperative chronic pain. Results A total of 80 patients were finally enrolled, including 40 patients in the awake group and 40 patients in the control group. The incidence of acute pain in PACU and during hospitalization stay in the awake group were significantly lower than that in the control group (50.0% vs 75.0%, P=0.021；50.0% vs 72.5%, P=0.039), but there was no statistical difference in chronic pain incidence between the two groups after operation (P>0.05). The percentage of patients with a Numerical Rating Scale (NRS) score≥4 points (moderate and severe pain) in the awake group in PACU was also significantly less than that in the control group (7.5% vs 27.5%, P=0.019). There was no significant difference between the two groups in the percentage of moderate to severe acute pain during hospitalization stay (P>0.05), and there was no significant difference in moderate to severe chronic pain after operation (P>0.05). Conclusions For awake anesthesia, the multi‑module analgesia based on adequate scalp nerve block can remarkably relieve acute pain after craniotomy, but further study is still needed to investigate its impact on chronic pain.