Curr Pediatr Res 2017; 21 (3): 403-409 ISSN 0971-9032 www.currentpediatrics.com Curr Pediatr Res 2017 Volume 21 Issue 3 403 Introduction Pain is the most distressful consequence of surgery with preventable complications in perioperative period [1,2]. However, expression of pain by younger children and even the method of pain assessment is more complex which makes children vulnerable to postoperative pain [3]. Studies showed that aggressive postoperative pain treatment in children with opioids and other analgesic alone were associated with many adverse effects [1,4-9]. Caudal epidural analgesia reduces the overall intraoperative anesthetic requirement and facilitates rapid return of conscious state with stable hemodynamic condition [1,4- 7,9-15]. However, perioperative pain relief with single shot caudal block is inadequate which needs further administration of other analgesic drugs intravenously [7,9,13,14]. So far, different additives like, opioids, ketamine and clonidine have been used to enhance postoperative pain relief but associated with undesirable side effects [3-7,9,12-14]. Neostigmine provide pain relief by preventing the breakdown of acetylcholine in spinal cord mediated by muscarinic and cholinergic receptors with minimal postoperative side effects [4,5,8,14,16]. Some studies showed that administration of neostigmine and bupivacaine prolong postoperative analgesia in children having lower extremity surgeries [3-6,8-10,12,14], whereas, other study pointed out that neostigmine did not prolong the duration of postoperative analgesia [7,17]. Objective To identify postoperative pain relief beneits of caudal neostigmine in children undergoing lower abdominal surgeries. Studies in this Review Study Design Randomized controlled trials. Eficacy of caudal neostigmine for postoperative pain relief: A systemic review and meta-analysis. Semagn Mekonnen 1 , Yigrem Ali 2 1 Department of Anesthesiology, College of Health and Medical Sciences, Dilla University, Ethiopia. 2 Department of Psychiatry, College of Health and Medical Sciences, Dilla University, Ethiopia. Caudal Epidural analgesia reduces the overall intraoperative Anesthetic requirement and facilitates rapid return of conscious state with stable hemodynamic condition. Different additives like, opioids, ketamine and clonidine have shown better pain management but brought about evitable complications. Addition of neostigmine improves pain management with minor postoperative complications. The purpose of this review was to compare caudal epidural neostigmine co-administered with bupivacaine and Bupivacaine alone. Different databases were explored to identify controlled clinical trials comparing neostigmine co-administered with bupivacaine and bupivacaine alone. Seventeen controlled trails have been collected for eligibility assessment and eleven trials were incorporated for extraction of outcomes. Eleven studies (838 participants) were included in this review. The mean difference of Postoperative analgesic duration was better in patients received neostigmine co-administered with bupivacaine when compared to bupivacaine alone (MD=3.29, 95% conidence interval (CI) 2.86 to 4.4, 4 trials, 193participants). There was signiicant association on postoperative analgesic consumption in 24 h when neostigmine group was compared with bupivacaine alone (SMD=-1.57, 95% conidence interval (CI) -2.14, 1.01, one trial, 63 participants). Conclusion: Caudal epidural with neostigmine co-administered with bupivacaine is better as compared to caudal epidural with bupivacaine. Abstract Keywords: Caudal epidural, Neostigmine, Bupivacaine, Postoperative analgesia. Accepted May 25, 2017