Objective To investigate the effect of intravenous lidocaine on postoperative fatigue syndrome （POFS） in patients undergoing laparoscopic resection for gastric carcinoma. Methods A total of 80 patients who underwent elective laparoscopic resection for gastric carcinoma at Xuzhou Central Hospital between September 2023 and June 2024 were enrolled. Inclusion criteria included age 18 ~ 75 years， ASA physical status classification Ⅰ~Ⅲ， body mass index （BMI） of 18.5 ~ 27.9 kg/m2， preoperative Christensen score ≤4， and estimated operation time ≤ 4 hours. Patients were randomly allocated into either the lidocaine group （Group L） or the saline group （Group C） using a random number table， with 40 patients in each group. Group L received an intravenous infusion of lidocaine at a dose of 1.5 mg·kg?1 over 15 minutes， initiated 30 minutes before anesthesia induction. If no adverse reactions occurred， lidocaine was maintained at a rate of 1.5 mg/（kg·h） throughout the surgery until its conclusion. Group C received an equivalent volume of normal saline administered in the same manner. The Christensen score and Visual Analogue Scale （VAS） scores were recorded on postoperative days 1， 3， 5， and 7， and the time-weighted average （TWA） of the Christensen score was calculated. Postoperative inflammatory markers were measured， and additional outcomes including extubation time， post-anesthesia care unit （PACU） stay duration， postoperative nausea and vomiting （PONV）， consumption of rescue analgesics， time to first flatus and defecation， and length of hospital stay were also documented. Results Compared with Group C， the TWA of the Christensen score in Group L decreased by 0.44 points （95% CI： 0.11 ~ 0.76； P < 0.05）. The VAS scores were significantly lower in Group L on postoperative days 1 and 3 （P < 0.05）. Levels of IL-6 and TNF-α at the end of surgery and 24 hours after surgery were also lower in Group L （P < 0.05）. The time to first flatus and defecation was significantly shorter in Group L （P < 0.05）. There were no significant differences between the two groups regarding extubation time， PACU stay duration， incidence of PONV， postoperative consumption of remedial analgesic drugs， or length of hospital stay （P > 0.05）. Conclusion Intravenous lidocaine may improve POFS in patients following laparoscopic resection for gastric carcinoma by attenuating inflammatory responses， alleviating pain， and facilitating gastrointestinal function recovery， while maintaining a favorable safety profile.