Abstract Background: Caudal anesthesia is a generally used regional anesthetic technique that can be useful in providing peri and postoperative analgesia. This study aimed to compare between the analgesic effect of adding ketamine to bupivacaine in caudal epidural block (CEB) for pediatric patients undergoing lower abdominal surgeries versus bupivacaine alone. Materials and Methods A total of 30 pediatric patients aged 1 - 3 years ASA I-II equally divided into two groups: Group C received general anesthesia GA and CEB using 0.25% bupivacaine 1ml/kg only. Group K received GA and CEB using 0.25% bupivacaine 1 ml/kg plus 0.5 mg/kg ketamine. Baseline HR and MAP were recorded then every 20 min till end of operation and at 1, 4, 8, 12hr. postoperatively Pain scores were evaluated by FLACC pain scale. Time of 1st analgesic rescue and its total doses were recorded. Results: The results showed there was highly significant difference between studied groups regarding intraoperative MAP and HR at 10min and 30 min after induction. There were highly significant differences between the studied groups regarding first time for rescue analgesia was longer in group K and total dose intra and postoperatively was lower in group K. As regard pain assessment, a significant increase in FLACC scale of group C compared with group K. Conclusion: The addition of 0.5 mg/kg ketamine as adjuvant to 1 ml/kg of 0.25% bupivacaine caudally safely prolongs the duration of postoperative analgesia.