Objectives 1. Identify how lidocaine infusion can be initiated and maintained in the hospital and at home. 2. Discuss mechanism, dosing, side effects, IV compatibility with opioids and monitoring of lidocaine infusion. M.E. was a 33-year-old mother of two with advanced peritoneal cancer who was at home with hospice care approaching the end of her life when she had to be hospitalized for refractory pain. Despite 3 years of aggressive chemotherapy, she had chronic small bowel obstructions that were no longer relieved with venting gastrostomy, and generalized abdominal pain unrelieved by her intrathecal pump with dilaudid 8 mg/day and bupivicaine, an infusion of fentanyl 400 mcg/hour with 400 mcg PCA, fentora 1600mcg Q3H PRN, and a trial of ketamine infusion. She was in severe pain, fatigued, and somewhat sedated but still able to communicate a primary goal of pain relief with a secondary goal of returning home for the end of her life. Due to suboptimal pain control and concern that increased dosing of opioids would result in sedation without providing acceptable pain relief; a lidocaine infusion trial was initiated. Our hospital did not have an established policy for initiation of lidocaine continuous infusion for the treatment of pain. However, with palliative care consultants providing a review of the literature to the nursing staff, the patient was allowed to receive this infrequently used therapy. Initial barriers were educating the nursing and house staff regarding monitoring of lidocaine infusion for toxicity. Lidocaine bolus of 1.5 mg/kg provided the patient significant pain relief and thus, lidocaine infusion was started at 1 mg/kg/hour and over 2 days titrated up to 2 mg/kg/hour. The patient tolerated the lidocaine well and was finally able to achieve her goal for pain control. Fentanyl PRN usage decreased dramatically and her fentanyl continuous infusion rate was decreased. The home hospice agency was able to continue administration of the lidocaine infusion 2 mg/kg/hour without difficulty and the patient returned home per her request to die in the presence of her family.