Background: Perioperative lidocaine infusion has been reported to reduce postoperative pain in patients after abdominal surgery; however, no study has examined lidocaine's effect on acute postoperative pain after supratentorial tumor surgery. Methods: A total of 94 patients scheduled for supratentorial craniotomy were enrolled. Patients received either lidocaine through an intravenous bolus (1.5 mg/kg) after induction followed by infusion at a rate of 2 mg/kg/h until the end of surgery or the same volume of normal saline. Mean arterial blood pressure, heart rate, and bispectral index were recorded at different intraoperative time points. Patients were assessed for pain in the postoperative anesthesia care unit (PACU) by the numeric rating scale (NRS). Other complications including hypertension, tachycardia, dysphoria, and postoperative nausea and vomiting (PONV) were reported. Results: There was no significant difference between the normal saline and lidocaine group for mean arterial blood pressure, heart rate, and bispectral index at any time point (P > 0.05). There was no significant difference in the incidence of hypertension, tachycardia, dysphoria, and PONY between groups (P > 0.05). The incidence of mild pain (NRS between 1 and 3) after surgery in PACU was lower in lidocaine group than that in the normal saline group (P = 0.014); the number of patients with an NRS pain score of 0 before leaving the PACU was significantly greater in the lidocaine group. No patient in either group had moderate or severe pain. Conclusions: Intraoperative infusion of lidocaine significantly decreases the proportion of patients with acute pain after supratentorial tumor surgery in the PACU.