Administration of intravenous lidocaine in the perioperative setting has found an increasing number of uses, with the strongest evidence supporting its use as an analgesic adjunct for abdominal surgery. However, several factors may give the clinician pause when considering its use even in this setting, including perioperative studies finding lidocaine serum concentrations in the toxic range despite conforming to a dosing regimen and wide variability between published dosing regimens. To address this issue, we perform a review of the literature to identify specific gaps in knowledge in lidocaine pharmacokinetics. We found an absence of studies looking at the effects of hepatic disease, renal disease, and mechanical ventilation on the pharmacokinetics of lidocaine infusions; available studies only address bolus dosing. In addition, conflicting data exist in pharmacokinetic modelling studies and recommended dosing regimens regarding total, ideal, or adjusted body weight as the standard for weight-based dosing. This review identifies elements of intravenous lidocaine pharmacokinetics that further research can serve to elucidate to increase confidence and precision in its use perioperatively.