Lidocaine has analgesic effect and antihyperalgesic and anti-inflammatory properties, which enable its use as a general anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, postoperative pain, and/or analgesic requirements. However, its mechanisms of action remain unclear, despite its different known properties. Although the exact mechanism of action remains uncertain, initial bolus followed by a continuous lidocaine infusion has clear analgesic benefits. Lidocaine is one of the major drugs for opioid-reduced anesthesia or opioid-free anesthesia procedures. It clearly improves the postoperative outcomes with increased patient satisfaction. Such procedures should be included wisely in the enhanced recovery after surgery protocols. By using the recommended protocols, a high safety and efficacy of lidocaine can be achieved.