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Background and Aims Radiotherapy-induced brachial plexopathy (RIBP) is a rare but debilitating complication of breast cancer treatment. There is limited information on the effective treatment for this condition. We describe a case of a patient diagnosed with RIBP who demonstrated excellent response to intravenous lidocaine infusion, with near-complete resolution of her symptoms.Methods A 68 year old female was referred to our pain clinic for severe left upper limb dysesthesia. She has a history of well-controlled schizophrenia and left breast cancer for which she underwent a left sided mastectomy with axillary clearance and chemoradiotherapy in 2017. She described her symptoms as a constant shock-like sensation radiating down her entire left arm. MRI of left brachial plexus and nerve conduction study were consistent with left brachial plexopathy. In view of her history of radiotherapy exposure to the left axilla, a diagnosis of RIBP was made.Results Despite starting and escalating her gabapentin dose to 300 mg TDS, converting to pregabalin 75 mg ON, and undergoing physiotherapy, her symptoms showed minimal improvement. Other neuropathic agents were limited because of her psychiatric history and use of multiple antipsychotics. She was started on a trial of intravenous lidocaine regimen consisting of a bolus of 1 mg/kg of 1% lidocaine followed by 1 mg/kg/h of 0.5% lidocaine for four hours over five consecutive days. She reported a significant reduction in her pain score on the numeric rating scale (0: no pain; 10: severe pain), improving from 10/10 to 3/10 after five cycles of lidocaine infusion, with no side effects. A follow-up clinic visit 9 months post-intervention showed persistent significant improvement in pain relief.Conclusions To our knowledge, this is the first report whereby IV lidocaine infusion has been used to successfully manage the symptoms of RIBP, highlighting its valuable role as part of the multimodal strategy for managing complex pain syndromes.