Introduction: Neuromuscular monitoring is the key component of the appropriate management of neuromuscular block.This type of monitoring allows safe timing and dosing of neuromuscular blocking and reversal agents.Since TOF monitor is not available in all the set ups,so a study was planned to see whether PI a very simple parameter can be used to check the intraoperative requirement of neuromuscular blocking drug and to compare the effects of Perfusion Index and TOF score on neuromuscular blockade intra-operatively. Methods: An observational study was done in 40 patients of ASA physical statusI,II,aged between 18-60 years of either sex scheduled for elective surgeries under General Anaesthesia.TOF score was recorded after stimulating the ulnar nerve before and after giving maintainence doses of neuromuscular agents.Perfusion Index and other hemodynamic vitals were also recorded at the same time intervals. Results: The TOF score recorded before giving the 1s,2nd and 3rd top up was reduced significantly(p value<0.05) ( mean±SD 0.34±0.09,0.36±0.12,0.3±0.8 respectively).However,the TOF score recorded at the time of giving top up was increased significantly(p value<0.05) compared to the score recorded before giving top up(mean±SD 0.59±0.11,0.62±0.14,0.63± 0.13respectively).The Perfusion Index did not show any statistical significant change(p value>0.05) before giving the 1st,2nd and 3rdmaintainance dose of neuromuscular blocking agents when compared with baseline value.However at the time of giving top up the decrease in perfusion index was significant (p value <0.05) at the time of giving 1st,2nd and 3rd top up.The hemodynamic parameters showed changes similar to Perusion index. Conclusion: The findings of our study show that TOF monitor can be used for assessing the need for neuromuscular blocking agent intra-operative.The changes in the hemodynamic parameters also match up with the changes in TOF score.Also the change seen in Perfusion Index was similar at the time of giving neuromuscular blocking agents and the changes in Perfusion Index correlated with TOF score and may be used in future for intra-operative neuromuscular block monitoring.