Seventy-two patients with femoral bone fractures and severe pain were randomized to receive intravenous pethidine (25 mg, n=36) or intravenous lidocaine (3 mg/kg, not exceeding 200 mg, n=36) infused over 20 minutes. The primary outcome of interest was pain reduction based on the numerical rating scale (NRS) at multiple time points over 60 minutes. Secondary outcomes included the incidence of adverse events and the need for rescue analgesia (fentanyl). Pain scores significantly decreased in both groups, but there was no statistically significant difference in pain relief between lidocaine and pethidine at any time point. Pethidine had a higher incidence of adverse effects, though this was not statistically significant. Additionally, female patients required significantly more rescue analgesics. Overall, these findings suggest that intravenous lidocaine provides similar analgesic efficacy to pethidine and may serve as an alternative to opioid-based pain management.