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Background and Aims Regional anaesthesia is part of multi-modal analgesia in paediatric surgery for effective pain relief. Traditional techniques like the Caudal Block (CB) and, more recently, facial plane blocks like the Erector Spinae Plane Block (ESPB) have gained popularity. This systematic review and meta-analysis compare CB and ESPB in paediatric lower abdominal and limb surgeries. It aims to clarify mixed outcomes from recent trials regarding the variability in analgesic efficacy of both techniques for future practices.Methods This review, registered with the International Prospective Register of Systematic Reviews (PROSPERO), includes eight randomized controlled trials comparing postoperative analgesia between ESPB and CB in paediatric lower abdominal and limb surgeries. We searched Science Direct, Google Scholar, Scopus, Proquest, and PubMed databases. The meta-analysis assessed the proportion of patients requiring rescue analgesia and post-operative pain intensity. GRADE guidelines were applied to assess the quality of evidence.Results Eight randomised controlled trials (575 patients) were included in the review. A meta-analysis of four RCTs (217 patients) showed reduced rescue analgesia with ESPB [OR = 0.55 (95% CI: 0.31, 0.96), p<0.05], while six RCTs (360 patients) found lower pain intensity score (SMD = -0.29, 95% CI: -0.51, -0.06; p<0.05) in the ESPB group. Both outcomes exhibited considerable heterogeneity (I 2 = 90% for rescue analgesia, I2 = 66% for pain intensity), further emphasizing the robustness of the findings.Conclusions We conclude that ESPB provides better postoperative analgesia than CB in children undergoing lower abdominal and lower limb surgeries. ESPB reduces postoperative pain intensity scores and analgesic requirements compared to CB.