EVALUATION OF EFFECTIVENESS OF PULSE OXIMETER PERFUSION INDEX OVER ANAL SPHINCTER TONE AS AN ASSESSMENT TOOL IN PREDICTING SUCCESSFUL CAUDAL BLOCK IN PEDIATRIC PATIENTS-A PROSPECTIVE OBSERVATIONAL STUDY

BHAVANA KOSGI; ROOPA HATTI; PRANAY P. BORALKAR

doi:10.22159/ijcpr.2025v17i1.6033

Authors

BHAVANA KOSGI Department of Anesthesia, Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka
ROOPA HATTI Department of Anesthesia, Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka
PRANAY P. BORALKAR Department of Pediatrics, Health and Family Welfare Department, Kalaburagi, Karnataka

DOI:

https://doi.org/10.22159/ijcpr.2025v17i1.6033

Keywords:

Caudal epidural block, Perfusion index, Pulse oximetry, Anal sphincter tone, Pediatric anesthesia, Regional anesthesia assessment, Block success prediction, Masimo Radical-7

Abstract

Objective: Caudal epidural block is widely used in pediatric surgeries for analgesia below the umbilicus. Traditional assessment methods like loss of anal sphincter tone are subjective and may not provide reliable feedback. The perfusion index (PI), measured non-invasively via the Masimo Radical-7 Pulse CO-Oximeter, may offer an objective alternative to predict block success.

Methods: In this prospective observational study, 50 pediatric patient’s aged 1 to 10 y undergoing elective lower abdominal surgeries received caudal epidural blocks under general anesthesia. Baseline PI values were recorded using the Masimo Radical-7 Pulse CO-Oximeter with the probe attached to the big toe. Measurements were taken at 1-minute intervals for 10 min post-block. Anal sphincter tone was assessed concurrently using a three-point qualitative scale by a blinded anesthesiologist. The primary outcome was the change in PI compared to baseline and its correlation with block success.

Results: Significant increases in PI values were observed in patients with successful caudal blocks. An increase in PI of more than 50% from baseline was associated with a 95% success rate of the block. The perfusion index showed a higher predictive value for block success (AUC = 0.88) compared to anal sphincter tone assessment (AUC = 0.72). The correlation between increased PI and successful block indicates that PI is a reliable indicator of caudal block efficacy.

Conclusion: The pulse oximeter perfusion index, measured using the Masimo Radical-7 monitor, is a more effective and objective tool than anal sphincter tone assessment in predicting successful caudal blocks in pediatric patients. Incorporating PI monitoring into perioperative care can provide immediate and reliable feedback, potentially improving anesthesia outcomes in children.

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