In the present study, the effect of procaine combined with ketamine and propofol in pediatric epidural anesthesia was analyzed. A total of 74 children scheduled to undergo surgery under epidural anesthesia were included in the study, and were divided into two groups using a random number table. Accordingly, 37 patients received epidural anesthesia using ketamine and propofol (control group), whereas the remaining patients received procaine combined with ketamine and propofol (observation group). The vital signs, sedative effects, anesthetic effects, pain intensity, anesthetic dose and incidence of adverse reactions were compared between the groups. It was revealed that the heart rate and mean arterial pressure at T4 (following epidural administration) in the observation group was significantly lower compared with those of the control group (P<0.05). However, no statistical difference was observed in the proportion of patients with sedation at Ramsay levels 1-6 between the observation and the control group (P>0.05). Compared with the control group, the observation group reported a shorter latent period for the onset of the anesthetic effect and the disappearance of pain, and a longer period for the recovery of pain sensation (P<0.05). The observation group exhibited prominently lower visual analog scale scores at 6, 12, 18 and 24 h post-surgery compared with the control group (P<0.05). Additionally, the observation group received a lower dose of ketamine and propofol compared with the control group (P<0.05). An incidence of adverse reactions of 8.11% was noted in the observation group during the surgery and anesthesia recovery period, which was lower compared with that of the control group (29.73%) (P<0.05). The results of the present study indicated that the combination of procaine with ketamine and propofol in pediatric epidural anesthesia may be more commonly employed, considering its advantages in accelerating the anesthesia process, improving the anesthetic effects and guaranteeing anesthesia safety. However, only a few indicators of the anesthesia efficacy and a small group of patients were included in the present study, and a long-term comprehensive analysis using a larger sample size is required to address this issue.