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Correlation of Block Success with Perfusion Index Measurement in Cases of Pediatric Surgery Under Caudal Epidural
Çiğdem Demi Rci1, Mehmet Duran2, Hamza Nakır1
1Anesthesiology and Reanimation Department, Adiyaman University Training and Research Hospital, Adiyaman, Türkiye.
Insights
Perfusion index (PI) effectively indicates successful caudal epidural blocks in pediatric surgery. This sensitive measure offers earlier detection of block success compared to heart rate or mean arterial pressure.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Caudal epidural block is crucial for pediatric lower extremity surgeries.
- Assessing block success is vital for patient safety and surgical efficiency.
- Perfusion index (PI) reflects vasomotor tone and may indicate block effectiveness.
Purpose of the Study:
- To compare the efficacy of perfusion index (PI), heart rate, and mean arterial pressure in detecting caudal epidural block success.
- To determine if PI is an earlier indicator of block success in pediatric surgical cases.
Main Methods:
- A randomized controlled trial involving 58 pediatric patients (ages 1-6 years).
- Caudal epidural block performed with 0.25% bupivacaine.
- Perfusion index, heart rate, and mean arterial pressure monitored at intervals up to 20 minutes post-block.
Main Results:
- A 100% increase in PI value by the seventh minute indicated successful block in all patients.
- Only 14.5% of patients showed the expected 15% decrease in mean arterial pressure.
- 45.6% of patients exhibited the expected 15% reduction in heart rate.
Conclusions:
- Increased PI values correlate strongly with successful caudal epidural block.
- PI is a more rapid, sensitive, and objective indicator than other monitored parameters.
- Utilizing PI allows for earlier adjustments in anesthesia management and faster surgical initiation.
Purpose:
One of the regional anesthetic procedures, caudal epidural block, is important for lower extremities surgeries in the pediatric patient population. The perfusion index (PI) value, which reflects vasomotor tone, can be used to indicate block success. The aim was to compare the role of perfusion index, heart rate, and mean arterial pressure in detecting the success of caudal epidural block and to investigate whether perfusion index was an earlier indicator in determining the success of the block in pediatric surgery cases.
Design:
A randomized controlled trial.
Methods:
The study included 58 patients, American Society of Anesthesiologists'classification 1, between the ages 1 and 6 years. In the left lateral decubitus posture, caudal epidural block was performed using a 23 or 25-gauge caudal needle and a dosage of 0.25% bupivacaine (1 mL/kg). At the 0, 1, 5, 7, 10, 15, and 20th minutes, peripheral oxygen saturation, heart rate, mean arterial pressure, and PI values were obtained using a probe attached to the first toe of the left foot. A successful caudal epidural block indication was defined as an increase of at least 100% in the PI value over the baseline value and a 15% decrease in mean arterial pressure and heart rate FINDINGS: PI represents the ratio of the photoplethysmography signal to pulsatile over nonpulsatile light absorbance. An increase in the PI value indicates that the block is effective. In the 20-minute follow-up period after caudal epidural block, there was at least a 100% increase in PI value in all of the patients at the seventh minute. An expected 15% reduction in mean arterial pressure was observed in 14.5% of the patients and an expected 15% reduction in heart rate was observed in 45.6% of the patients.
Conclusions:
The results obtained from our study show that the increase in PI values is associated with caudal epidural block success. The PI value is more rapid, sensitive and objective than those produced by other parameters. Benefits include an earlier change in anesthesia management due to block failure and faster initiation to surgery, which reduces exposure to anesthetic chemicals.
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