Objective To evaluate the efficacy and safety of epidural neostigmine in management of labor pain. Methods Randomized controlled trials (RCTs) about epidural neostigmine combined with local anesthetics or opioids (experimental group) versus local anesthetics or opioids alone (control group) in management of labor pain were retrieved from Cochrane Library, PubMed, EMbase, Wanfang Database, CNKI, and CBMdisc from the date of their establishment to September 2011. The methodological quality of included RCTs was evaluated by two reviewers independently, and meta-analysis was conducted with the included RCTs using RevMan 5.1.4 software. Continuous variables were dealt with mean difference and 95% confidence interval(CI), and the dichotomous variables were dealt with odd ratio and 95% CI. Results We identified 4 RCTs including 282 patients. The results of meta-analyses showed that the values of visual analogue scale (VAS) were significantly lower in the experimental group compared with the control group