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Category: Volume 10 Issue 03 March 2022
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Title: A Comparative Evaluation of Peripheral Perfusion Index vs Anal Sphincter Tone to assess the Onset of Caudal Block in Pediatric Lower Abdominal Surgeries

Authors: Dr R. Amutha Rani, Dr R. Janaki, Dr R. Vinodhini

 DOI: https://dx.doi.org/10.18535/jmscr/v10i3.04

Abstract

Background: In pediatric lower abdominal surgeries, caudal block approach is better and efficient than general anaesthesia and provides excellent post-op pain control. Onset of caudal block is assessed by loss of cremasteric reflex, hemodynamic changes, loss of anal tone and increase in perfusion index. Studies comparing the predictors for onset of caudal block are very limited and not much of studies is about perfusion index.

Aims & Objectives: To compare if the onset of caudal is first demonstrated by rise in PI or by loss of anal sphincter tone and to emphasize the importance of peripheral perfusion index.

Methodology: This is a Prospective Randomized single blinded study in Pediatric surgery Operation Theatre, TVMCH, with a sample size of 100 Children of age <8 years belonging to ASA I or II. Patient premedicated. Monitors connected. Peripheral IV line secured. Pre-procedural vitals noted. Perfusion index in lower limb noted. Caudal block is given in aseptic conditions using 22G hypodermic needle with bupivacaine 0.25% in a volume of 1ml/kg. Throughout the    procedure the child is thoroughly monitored and all vitals are recorded. Earliest increase in PI is noted using masimopulse-oximeter. Followed by this PI is noted at 2 mins, 5 mins, 10 mins and 20 mins (P1,P2,P3,P4 respectively). Using sterile glove and lignocaine jelly, laxity of anal tone (DRESS Score) is recorded at 5 mins, 10 mins and 20 mins (A1, A2, A3 respectively).

Results: Perfusion index is an objective & non-invasive monitor that predicts the caudal onset much earlier than Anal sphincter tone as evidenced by the study.

Keywords: Caudal anaesthesia, perfusion index, anal sphincter tone.

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Corresponding Author

Dr Amutha Rani R MD

Prof & HOD, Department of Anaesthesiology, Tirunelveli Medical College