{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:42Z","timestamp":1786649682186,"version":"build-2736575974"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Caudal block is a widely practiced regional anesthetic technique in pediatric patients undergoing infraumbilical and lower limb surgeries. However, assessing its effectiveness intraoperatively remains a challenge due to limitations in conventional clinical evaluation methods, especially under general anesthesia. The perfusion index (PI), a noninvasive indicator of peripheral perfusion, has emerged as a potential early marker of successful neuraxial block.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To evaluate the perfusion index as a primary predictor of successful caudal block in children undergoing elective infraumbilical and lower limb surgeries, and to compare it with traditional hemodynamic parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective observational study was conducted over two years at a tertiary care center. A total of 80 pediatric patients (ASA I\u2013II, aged 1\u20138 years) undergoing elective surgeries under general anesthesia with caudal block were enrolled. PI, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at multiple time intervals post-block. The primary outcome was the change in PI; secondary outcomes included changes in hemodynamic parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A significant increase in PI was observed as early as 3 minutes after caudal block, rising from a baseline of 1.55 \u00b1 1.08 to 3.96 \u00b1 1.94 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), with a peak at 30 minutes (5.23 \u00b1 1.42). In contrast, SBP, DBP, and MAP showed significant reductions only after 15 minutes. SpO\n                      <jats:sub>2<\/jats:sub>\n                      remained stable throughout. The early rise in PI correlated with successful block onset and duration, making it a reliable early predictor compared to delayed hemodynamic changes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_379_25","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:01:04Z","timestamp":1756900864000},"page":"594-599","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Perfusion index as primary predictor of successful caudal block in infraumbilical and lower limb pediatric surgeries: A prospective observational study"],"prefix":"10.4103","volume":"19","author":[{"given":"Sravya","family":"Bejugama","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonal Sagar","family":"Khatavkar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"1061e9","DOI":"10.1111\/j.1460-9592.2010.03448.x","article-title":"Association des Anesthe sistes Re animateurs Pe diatriques d\u2019Expression Franc aise (ADARPEF). Epidemiology and morbidity of regional anesthesia in children: A follow-up one-year prospective survey of the French-Language So- ciety of Paediatric Anaesthesiologists (ADARPEF)","volume":"20","author":"Ecoffey","year":"2010","journal-title":"Paediatr Anaesth"},{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"1353e64","DOI":"10.1213\/ANE.0b013e31825d9f4b","article-title":"Paediatric Regional Anesthesia Network (PRAN): A multi-institutional study of the use and incidence of complications of pediatric regional anesthesia","volume":"115","author":"Polaner","year":"2012","journal-title":"Anesth Analg"},{"key":"R3-20260421","first-page":"223","article-title":"Evaluation of perfusion index (PI) efficiency in pediatric caudal block: Is it the time to depend on PI?","volume":"83","author":"El-Sonbaty","year":"2015","journal-title":"Med J Cairo Univ"},{"key":"R4-20260421","first-page":"453","article-title":"Caudal anesthesia in pediatrics: An 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block","volume":"105","author":"Uemura","year":"2006","journal-title":"Anaesthesiology"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4103\/0970-9185.182106","article-title":"Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine","volume":"32","author":"Baduni","year":"2016","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"635","DOI":"10.4103\/joacp.JOACP_34_21","article-title":"Perfusion index as a predictor of working pediatric caudal block under general anesthesia-A prospective observational study","volume":"38","author":"Rajan","year":"2022","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R10-20260421","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4103\/joacp.joacp_228_22","article-title":"Evaluation of perfusion index as a predictor of successful caudal block in pediatric patients: A prospective randomized study","volume":"40","author":"Vashishth","year":"2024","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R11-20260421","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.4097\/kjae.2007.53.6.S19","article-title":"Pulse oximetry and skin temperature gradient as diagnostic tools of successful caudal block","volume":"53","author":"Kim","year":"2007","journal-title":"Korean J Anesthesiol"},{"key":"R12-20260421","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1111\/j.1399-6576.2009.01968.x","article-title":"Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia","volume":"53","author":"Ginosar","year":"2009","journal-title":"Acta Anaesthesiol Scand"},{"key":"R13-20260421","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/11101849.2023.2301218","article-title":"Comparison of two different methods as reliable predictors of successful caudal block in children","volume":"40","author":"Essam Elfeil","year":"2024","journal-title":"Egypt J Anaesth"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_379_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:00Z","timestamp":1786647420000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_379_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_379_25","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]},"assertion":[{"value":"2025-05-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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