Fourty-eight adolescents with idiopathic scoliosis were randomized to receive perioperative IV lidocaine (n = 24) or saline placebo (n = 24) as an adjunct to standardized multimodal analgesia that included protocolized morphine titration, acetaminophen, ketorolac, and clonidine during . The primary outcome was cumulative 48-hour morphine utilization (mg/kg). Secondary outcomes included morphine use at 12/24/36 h, median and worst pain scores, time to first stand and to walk >15 steps, urinary catheter removal, cessation of morphine infusion, and hospital length of stay, assessed through 48 hours (with LOS in days). Overall, the results of the study revealed no difference in 48-hour morphine use between groups (0.86 vs 1.00 mg/kg; p = 0.264) and no differences in other outcomes, except for a lower first postoperative pain score with lidocaine (median 3/10 vs 5/10; p = 0.035). In short, within an effective multimodal regimen, adjunctive 48-hour IV lidocaine did not reduce opioid requirements or meaningfully change recovery metrics.