Lumbar spine fixation surgery is frequently associated with poor postoperative recovery due to advanced age, baseline pain, limited mobility, acute postoperative pain and high perioperative opioid requirements. Early postoperative recovery is a key determinant of long-term functional outcomes following spine surgery. Esmolol is an ultra-short-acting beta-one selective adrenergic blocker commonly used intraoperatively for heart rate and blood pressure control and has demonstrated analgesic and opioid sparing effects in various surgical procedures. However, its impact on the overall quality of recovery after spine surgery has not been adequately studied. 

The study hypothesizes that intraoperative esmolol infusion improves postoperative quality of recovery compared to placebo, as assessed by the Quality of Recovery 15 score. This study is a prospective randomized double blind placebo controlled trial designed to evaluate the effect of intraoperative esmolol on postoperative recovery in adults undergoing lumbar spine fixation surgery in the prone position under general anesthesia

A total of 96 adult patients ASA physical status I to III scheduled for multi-level lumbar spine fixation surgery will be randomized into two groups The esmolol group will receive an intravenous loading dose of esmolol 0.5 mg per kg at induction followed by a continuous infusion 50 to 150 microgram per kg per minute titrated to maintain heart rate and mean arterial pressure within 20 percent of baseline until extubation The placebo group will receive an equivalent volume of normal saline following an identical protocol perioperative anesthesia management will be standardized in both groups

This study aims to determine whether intraoperative esmolol can enhance postoperative recovery while reducing opioid consumption and maintaining perioperative hemodynamic stability in patients undergoing lumbar spine fixation surgery.