Background: Excessive bleeding during spine surgery is a serious issue, posing a significant risk of significant blood loss and complicating the surgical approach.

Methods: This was a double-blind prospective randomized controlled investigation that was carried out on 45 participants undergoing lumbar spine surgery in the operating room at Menoufia University Hospital. Randomization was made by a computer-generated program into three equal parallel groups that were randomly assigned to either first group receiving oral atenolol (Group A n=15) ,second group receiving propranolol(Group P n=15) and third group receiving Ivabradine (Group I n=15) 90 min before onset of operation. The primary goal was to measure the effect of these drugs on heart rate, other secondary goals included the effect on blood pressure, surgeon satisfaction, blood loss and surgical field visibility according to Fromm and boezaart score, also the occurrence of any side effects were reported.

Results: A significant decrease in heart rate has been observed between groups at all-time points (p < 0.05) except at baseline, after medication, and 30 minutes post-operatively (p > 0.05). However, heart rate was highest in Group P and lowest in Group I. surgeon satisfaction was higher in Ivabradine group (grade 1: 66.7%) than group A (grade1: 33.3%) and group P (grade 1:20%), while there was No significant difference in blood loss, surgical field visibility or reported side effects (p > 0.05).

Conclusion: Our investigation revealed Ivabradine significantly lowers heart rate compared to propranolol and atenolol with better surgeon satisfaction and decreased Bleeding.