Introduction: Pain is a subjective phenomenon that can evoke a sense of innate fear and anxiety. So, pain control should be the main stay of any treatment protocol in dentistry especially for children. Even though it is very well managed pre and intra operatively, a situation possibly arises post operatively. Administration of pre-emptive analgesia could be one of the methods used in the management of post operative pain. This systematic review aimed to evaluate the efficacy and safety of pre-emptive analgesia for primary tooth extractions in children. Methods: PubMed, Ovid SP, Cochrane databases were filtered from years 1980 up to July 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria independently by two reviewers. Studies that compared pre-emptive analgesic administration in comparison with placebo for primary tooth extractions in children were evaluated. The outcome sought for were self-reported post-operative pain (patient perceived pain), total number of rescue analgesics consumed in the post-operative follow up period. Results: A total of six studies were included for the final evaluation. Most of the studies report lower self-reported post-operative pain scores(n=3), and lower rescue analgesic consumption(n=3), in pre-emptive group in comparison to placebo. Conclusions: Pre-emptive analgesic administration might have a positive effect on above mentioned parameters during primary tooth extraction in children, but more evidence is needed to justify the same.