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Evaluation of perfusion index as a predictor of successful caudal block in pediatric patients: A prospective
Sumedha Vashishth1, Nancy Nandal2, Kiranpreet Kaur2
1Department of Anaesthesiology, Pt. B. D. SHARMA, PGIMS, Rohtak, Haryana, India.
Insights
Perfusion index (PI) effectively monitors caudal block success in pediatric patients, offering a faster, noninvasive alternative to anal sphincter tone (AST). This method provides early feedback on regional anesthesia efficacy.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Caudal block is a common regional anesthesia technique in children.
- Current assessment methods for caudal block efficacy lack speed and reliability.
- Perfusion index (PI) shows promise as a sensitive indicator for caudal block effectiveness.
Purpose of the Study:
- To evaluate the perfusion index (PI) as an early indicator of successful caudal block in pediatric patients.
- To compare the efficacy of PI with anal sphincter tone (AST) in assessing caudal block onset.
Main Methods:
- Sixty pediatric patients undergoing lower abdominal surgery were randomized into two groups.
- Group 1 received caudal block with general anesthesia; Group 2 received general anesthesia alone.
- Perfusion index (PI) and anal sphincter tone (AST) were measured at intervals post-anesthesia induction.
Main Results:
- Group 1 demonstrated a significant and persistent increase in PI from 5 to 20 minutes compared to Group 2 (P = 0.001).
- Progressive laxity of AST was observed in Group 1, significantly differing from Group 2 (P < 0.001).
- PI showed a statistically significant increase in the caudal block group.
Conclusions:
- Both PI and AST are reliable indicators for assessing caudal block success in pediatric patients.
- PI is a simpler, more economical, and noninvasive monitor that predicts caudal block onset earlier than AST.
- Perfusion index offers a valuable tool for real-time assessment of regional anesthesia in pediatric procedures.
Background And Aims:
Caudal block is among the most widely administered regional anesthesia in pediatric patients. The clinical signs and objective assessments are not fast and reliable enough to provide a good feedback. Perfusion index (PI) is considered as a sensitive marker to assess the efficacy of caudal block. We aim to assess PI as an indicator for success of caudal block in pediatric patients.
Material And Methods:
Sixty pediatric patients scheduled for elective surgery of lower abdomen and below were included. Patients were randomly allocated into two groups (n = 30): Group 1 received caudal block after general anesthesia and Group 2 only received general anesthesia. PI, heart rate, mean arterial pressure, and anal sphincter tone (AST) were recorded at 5, 10, 15, and 20 min following induction of anesthesia.
Results:
A persistent increase in the PI value was observed in Group 1 starting from 5 min till 20 min, as compared to Group 2, at all the time intervals. When mean PI was statistically compared between both the groups, it was found to be highly significant (P = 0.001). Group 1 patients have progressive laxity of AST which was found to be significantly different from Group 2 (P < 0.001).
Conclusion:
We have found that both PI and AST are good indicators for assessing success of caudal block onset in pediatric patients but AST took slightly longer time (~20 mins). Therefore, we conclude that PI is simple, economical, and noninvasive monitor that predicts the caudal onset much earlier than AST.
