Investigation of the correlation of block success with perfusion index measurement in cases of pediatric surgery performed under caudal epidural block anesthesia

OBJECTIVE: Caudal epidural block (CEB) is the most commonly used regional anesthesia method in sub-umbilical surgical procedures in pediatric patients. Recently, studies are carried out on the Perfusion Index (PI) value measured by pulse oximetry technology to evaluate the success of regional anesthesia. In our study, we aimed to investigate whether it can be used as a fast, reliable and objective method to evaluate the block success with the PI value in pediatric surgery cases who underwent CEB under general anesthesia (GA). METHODS: It was planned to include 60 patients aged 1-6 years in the ASA (American Society of Anesthesiologists) I group, who would undergo hypospadias, undescended testis, inguinal hernia or circumcision operations. After induction of general anesthesia, our patients were placed in the left lateral decubitus position. The legs and head were brought to the flexed position. The patient's airway was maintained with mask ventilation. The patients were placed in the supine position after CEB was performed and fitted with a LMA. The procedure was terminated in 2 cases since the caudal epidural area of one petient could not be found and epidural vein was punctured in another. In our remaining 58 patients who continued the study, at the 0th minute (after GA induction and before starting the block application) and at the 1, 5, 7, 10, 15 and 20th minutes (after the block appication), non-invasive mean arterial pressure (MAP), heart rate, oxygen saturation (SpO2) and. PI values measured by attaching a probe to the big toe of the left foot were recorded. RESULTS: Our block was successful in 55 of 58 patients who underwent CEB, and PI values increased continuously from the 1st minute during the 20 minutes of observation period after CEB was performed. When the PI value was compared to the initial value, at least 100% increase was observed in 78.2% of the patients at the 5th minute, while it was observed in all of the patients at the 7th minute. In patients with unsuccessful block, no statistically significant difference was found in the PI value during 20 minutes. CONCLUSION: The PI value is an invaluable and easy-to-use method that provides early, sensitive and more objective results compared to other parameters to show the success of CEB applied under general anesthesia in pediatric patients