We conducted a randomized, double-blind trial to compare the efficacy of preincisional and postincisional wound infiltration with 1% lidocaine (40 mL) on the postoperative pain of 37 patients scheduled for elective inguinal herniotomy. The demand for additional postoperative analgesics occurred earlier in those who received lidocaine infiltration after incision (165 min) than in those who received preincisional lidocaine (225 min, P less than 0.05). The preincisional lidocaine infiltration group also had fewer patients requiring supplemental analgesics (58%) than the postincisional group (94%) (P less than 0.05). We conclude that preincisional infiltration of the surgical wound with lidocaine is a more effective method of providing postoperative analgesia than is postincisional infiltration.