Lidocaine is an amide-type local anesthetic that was initially used as an antiarrhythmic agent for intravenous injection. Recently, intravenous lidocaine (IVL) has been proposed as an attractive adjunctive analgesic intervention. Lidocaine possesses analgesic, anti-hyperalgesic, perioperative complication-reducing, and anti-inflammatory properties, hence its increasing use in the perioperative period. IVL significantly alleviates propofol-induced injection pain, streamlines intraoperative anesthesia management, decreases opioid usage, shortens hospital stays, and promotes postoperative gastrointestinal function recovery. At recommended doses, lidocaine demonstrates a high therapeutic index, with blood concentrations typically maintained below the thresholds for cardiac and neurotoxicity, ensuring a high level of safety. This article will focus on discussing the protective mechanisms, recommended dosages, personalized dosing, safety profile, and the progress of research on clinical applications of lidocaine in intravenous infusion during the perioperative period.