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Fentanyl is one of pain medication usually used in anesthetic practice and one common problem after intravenous injection is inducing cough. A 0.5 mg/kg of lidocaine could suppress fentanyl-induced cough, however, the side effect of exceeding doses of lidocaine may cause arrhythmogenic effects and the vasodilatory effects of lidocaine may possibly aggravate cardiovascular depression. The study aimed to compare the efficacy of 0.25 mg/kg and 0.5 mg/kg intravenous lidocaine regarding fentanyl-induced cough in general anesthesia. This study was a randomized double-blinded controlled trial. In all 139 participants, who underwent elective surgery between the ages of 18 to 60 years, were allocated in two groups, to receive lidocaine 0.25 mg/kg and 0.5 mg/kg over two minutes before 1 μg/kg of intravenous fentanyl. Coughing was assessed and classified into 3 grades as mild, moderate, or severe. The risk factors of fentanyl-induced cough and side effects were also noted. Thirteen patients (18.8%) in the 0.25% lidocaine group and eleven patients (15.7%) in the 0.5% lidocaine group experienced fentanyl induced cough. No significant difference was found in the incidence and severity of cough between the two groups (P> 0.05). The present findings indicated that pre-operative IV lidocaine 0.25 mg/kg could be considered an alternative dose to suppress fentanyl-induced cough.