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Background and Aims Multimodal analgesia is a common approach for postoperative management of posterior spinal fusion (PSF) for patients with adolescent idiopathic scoliosis (AIS). Recent studies have evaluated intraoperative intravenous lidocaine infusions (IVLI) and liposomal bupivacaine (LB) injection to optimize postoperative analgesia in pediatric spine patients. Both individual studies of IVLI and LB showed an opioid-sparing effect in children undergoing major spinal procedures compared to placebo. The aim of this study was to compare the effects of IVLI to LB injections on postoperative pain management and recovery.Methods A retrospective chart review was performed between April 2023 to August 2024 on 20 patients who underwent PSF for AIS. Ten patients received LB and 10 patients received IVLI intraoperatively. Data collected included demographics, ASA status, vertebral levels, surgical time, postoperative pain scores, postoperative and total opioid use, antiemetic use, and length of stay (LOS). Analysis was performed using Fisher’s Exact Test, Mann-Whitney U Test, Wilcoxon rank sum test, and t-test.Results There were no significant differences in age, gender, ASA status, vertebral levels between the two groups. There was a significant difference in weight between the two groups (p<0.01). There were no significant differences in hospital LOS, postoperative pain scores, and postoperative antiemetic used. There was a significant reduction in morphine milligram equivalents per kg (MME/kg) in patients who received IVLI compared to LB (p=0.01). There was also a significantly longer surgical time in the IVLI group compared to liposomal bupivacaine group (p=0.01).Abstract OP37 Figure 1Mean morphine milligram equivalent/kilogram requirement between the intravenous lidocaine group and the liposomal bupivacaine groupConclusions Though evidence supports the use of both LB and IVLI, intraoperative IVLI was associated with a significant reduction in total postoperative opioid requirement compared to LB in AIS patients undergoing PSF. A larger study is warranted to further assess the role of IVLI in these patients.