الفهرس 
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Abstract
This prospective, randomized, double -blinded study was conducted at Minia university hospital, during the period from November 2017, to December 2018. The study involved 100 patients of both gender, aged between20-60 years old, and patients physical status American Society of anesthesiologists (ASA) class I and II, scheduled for posterior approach lumbar fixation surgery 3levels or less , under general anesthesia, and written informed consent from each patient was obtained.
Our objectives were to assess the efficacy of multimodal post-operative analgesia and hemodynamic changes intra and post-operative primary, and prevent post-operative complications, decrease fentanyl consumption secondary after lumbar spine fixation in the study patients.
Patients were randomly divided into four equal groups: 25 patients in each group):
• group GC: received gabapentin 300mg + celecoxib 200mg 2hr preoperative and the same combination 6 hr postoperative.
• group G: received gabapentin 300mg + celecoxib 200mg 2hr preoperative and gabapentin 300mg 6 hr postoperative.
• group C: received gabapentin 300mg + celecoxib 200mg 2hr preoperative and celecoxib 200mg 6 hr postoperative.
• group O: (placebo) as control group received 2 empty capsules 2hr preoperative and the same 6 hr postoperative.
All patients were assessed with regards to:
Preoperative (anxiety score, RBS) intraoperative (hemodynamics (MAP, HR, So2), end tidal isoflurane concentration, RBS and intraoperative analgesic requirement), postoperative (VAS score, hemodynamics (MAP, HR, So2, RR), patient satisfaction score, first time of fentanyl request, total fentanyl requirement and occurrence of complication ).
Results of this study found that regard Patient‘s characteristics age, sex, cause of operation and duration of surgery were comparable in all studied groups.
Preoperative anxiety score was significantly lower in the three groups (GC, G and C) when compared with group O.
Intraoperative hemodynamics (MAP, HR), BIS value, end tidal isoflurane concentration, RBS and frequency of analgesic requirement were significantly lower in the three groups (GC, G and C) respectively when compared with group O.
Postoperative VAS score was significantly lower in the three groups (GC, G and C) respectively when compared with group O.
Postoperative hemodynamics (MAP, HR and RR) were significantly lower in the three groups (GC, G and C) respectively when compared with group O.
The 1st time of fentanyl requirement was delayed in the three groups (GC, G and C) respectively when compared with group O.
Postoperative total fentanyl requirement was significantly lower in the three groups (GC, G and C) respectively when compared with group O.
Postoperative patient satisfaction score was significantly higher in the three groups (GC, G and C) respectively when compared with group O.
Postoperative complications in form of vomiting, nausea and drowsiness show insignificant different between groups.
We conclude that preoperative and post-operative combination of gabapentin 300mg and celecoxib 200mg provide lower preoperative anxiety score, better intraoperative (hemodynamics , ,RBS ,anesthetic requirement and analgesic requirement ) , lower post-operative (VAS score of pain, RBS and analgesic requirement) higher patient satisfaction score when compared with using every drug alone or placebo respectively in patients who underwent spine fixation surgery.