Objective To investigate the effect of lidocaine on the comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery. Methods This is a randomized, single-blind, parallel controlled clinical trial. A total of 106 patients undergoing elective oral and maxillofacial surgery in the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from Apr. to Jun. 2020 were selected and randomly divided into 3 groups (transnasal endotracheal intubation was indwelled for more than 12 h after surgery in all patients): lidocaine pumping group (35 cases, injected intravenously with 1.5 mg/kg [20 mg/mL] loading dose of lidocaine in surgical intensive care unit [SICU] after operation, and then pumped with 1.5 mg·kg^－1·h^－1 [diluted to 10 mg/mL with normal saline] for 12 h), lidocaine spray group (35 cases, lidocaine aerosol sprayed twice every 2 h through artificial airway with an interval of 2 min and 2 sprays each time in SICU after operation) and control group (36 cases, injected with 0.075 mL/kg loading dose of normal saline intravenously in SICU after operation, and then pumped with 0.15 mL·kg^－1·h^－1 infusion continued to 12 h). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), visual analogue scale (VAS) score of incision pain, VAS score of postoperative sore throat, and frequencies of nausea/vomiting and cough were recorded every hour in SICU. Results Compared with the control group, no significant differences were observed in the SBP, DBP, MAP or HR in the lidocaine pumping group and lidocaine spray group (all P>0.05). However, the RR of the patients in both groups were lower than that in the control group (both P<0.05). As for comfort signs, lower VAS scores of postoperative sore throat and lower frequencies of nausea/vomiting and cough were recorded in the lidocaine pumping group and lidocaine spray group (all P<0.05); the VAS scores of incision pain were decreased in the lidocaine pumping group (P<0.05), but were similar in the lidocaine spray group and control group (P>0.05). Patients in the lidocaine pumping group had lower VAS scores of incision pain and postoperative sore throat and lower frequency of cough than patients in the lidocaine spray group (all P<0.05). The SBP, MAP and the frequencies of nausea/vomiting and cough in the patients of both treating groups were decreased during 1-12 h in SICU (all P<0.05), and the DBP was also decreased in the lidocaine pumping group (P<0.05). Only frequencies of nausea/vomiting and cough were decreased in the control group (both P<0.05). Conclusion Lidocaine intravenous and surface anesthesia can improve the comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery, without causing serious adverse reactions. Furthermore, intravenous injection way is more effective.