Lidocaine has been used as an anesthetic and analgesic for more than half a century. First synthesized in 1943, the injectable formulation of lidocaine was approved for local and regional anesthesia in the United States on November 19, 1948. Since that time, a variety of intravenous, intramuscular, and topical methods for administering lidocaine have been developed. The transdermal lidocaine 5% patch (Lidoderm®) was approved by the Food and Drug Administration on March 19, 1999 for relief of pain associated with post-herpetic neuralgia in adults. Use of the patches has expanded to other chronic pain syndromes and to the management of postoperative pain in children as well as adults. Continuous lidocaine infusions offer another option for providing analgesia. Although not well studied in pediatric patients, this technique has the potential to reduce reliance on opioids and may prove to be a valuable addition to pain management in children.