Caudal epidural analgesia is one of the most commonly used regional anesthesia techniques in children undergoing infraumbilical surgery. Bupivacaine provides effective postoperative pain control; however, its duration may be limited. Fentanyl has been used as an adjuvant to prolong analgesia. To compare the efficacy and safety of caudal bupivacaine alone versus caudal bupivacaine combined with fentanyl in pediatric patients undergoing elective infraumbilical surgery. This prospective controlled comparative study was conducted between May 2025 and May 2026 at Misurata Medical Center and the National Cancer Institute, Misurata, Libya. 67 children aged 1 - 6 years with ASA physical status I - II were included. 38 patients received caudal bupivacaine 0.2% (Group A), while 38 received caudal bupivacaine plus fentanyl (Group B). The primary outcome was time to first rescue analgesia. Intravenous paracetamol 20.0 mg/kg was administered when postoperative analgesia was required. Demographic characteristics and duration of surgery were comparable between groups. The mean time to first rescue analgesia was significantly longer in Group B (9.50 ± 0.88 hrs) than in Group A (5.42 ± 1.10 hrs). Postoperative vomiting occurred in three patients in Group A and five patients in Group B. No respiratory depression or pruritus was observed. The addition of fentanyl to caudal bupivacaine significantly prolonged postoperative analgesia without increasing major adverse effects.