Objective To explore the feasibility of photoplethysmography in monitoring the changes of noxious stimulation intensity caused by veress needle insertion during pediatric laparoscopic hernia repair. Methods Ninety pediatric patients (2-4 years old) with the American Society of Anesthesiologists (ASA) grade ofⅠ-Ⅱ scheduled for laparoscopic hernia repair surgery were randomized into three groups (n=30): group A, B, and C. After tracheal intubation of general anesthesia induction, the pediatric patients in group A received intravenous 0.1 μg/kg sufentanil 5 min before veress needle insertion, group B received 0.1 μg/kg sufentanil immediately after placing the veress needle, while group C received veress needle insertion without sufentanil. The photoplethysmographic amptitude (PPGA) from right forefinger, and surface electromyography (sEMG) of abdominal muscles of pediatric patients were recorded at 6 min prior to veress needle insertion (that is 1 min before receiving sufentanil in the group A, and the injection time was not included, T1), immediately after veress needle insertion (T2), and at 5 min after veress needle insertion (that is 5 min after administration of sufentanil in the group B, T3). Results The values of PPGA had no significant difference between T1, T2 and T3 in group A (P>0.05). Compared with T1 and T3, the value of PPGA at T2 was significantly decreased in group B (P<0.05). The values of PPGA at T2 and T3 were significantly decreased compared with T1 in group C (P<0.05). PPGA was negatively correlated with sEMG in three groups (r=-0.601, -0.512, -0.613; P<0.05). Conclusion Photoplethysmography can quantify the changes of noxious stimulation intensity in pediatric laparoscopic hernia repair and has good application values.