Group PE will receive the following preemptive multimodal pharmacologic agents-,Intravenous diclofenac 75 mg, intravenous morphine 3mg, 1gm of intravenous acetaminophen and 75mg pregabalin per orally.

After assessing for eligibility, patients will be explained about the study protocol, the use of the PCA pump, numerical rating score (NRS) and written informed consent will be obtained. All patients will be explained to report pain intensity on a VAS score of 0-10 where 0= no pain and 10= worst possible pain. For descriptive purposes, pain score between 0-3 will be taken as mild pain, 4-7 as moderate pain, 7-9 as severe pain and 10 as intolerable pain.

One hour prior to surgery, the sealed envelope will be opened and the card inside will determine the group allocation. The drugs will be administered at least 1 hour before surgery by a blinded anesthesiologist who will not participate in post operative assessment.

After securing intravenous cannula and adequate hydration with Ringer lactate , spinal anesthesia would be initiated with 3ml of 0.5% hyperbaric bupivacaine. In case general anesthesia is required, standard institute protocol shall be followed. All patients will be managed intraoperatively with combined spinal epidural anesthesia or general anesthesia with the same perioperative departmental protocol. Type of surgery, duration of surgery, baseline haemoglobin, blood loss, no of hypotensive episodes, intraoperative blood transfusion, intraoperative use of opoids and NSAIDS will be noted. The attending anesthesiologist will not be involved in the patients’ evaluation post-operatively.

All patients will be connected to a patient-controlled epidural analgesia pump (PCEA Plus; Abbott, Chicago, IL, USA) or Patient controlled analgesia upon arrival in the post-anesthesia care unit.. The patients will be instructed to push the button of the PCEA system or PCA each time they felt pain. The patient-controlled analgesia will be set at a bolus of 5 ml of 0.2 % ropivacaine with 2μgm/ml of fentanyl with a lockout time of 30 min in or 2ml of 1mg/kg morphine  At any point of time, if patient complains of pain with NRS>3, morphine 3mg will be given as rescue analgesia and time recorded.. Postoperative NRS scores will be recorded when the patient is admitted to the trauma recovery room, after 30 min, 1 hr, 2 hrs, 4hrs, 8hrs, 12 and 24 hrs and on postoperative day 2. Postoperative nausea, vomiting, sedation scores will be assessed at arrival time, 6 hrs and 24 hrs. Any episodes of respiratory depression, apnea, hypoventilation, desaturation will be noted.