Over the last few decades, there has been a growing interest in developing innovative drug delivery approaches that can assist drug release to attain the vital extent of therapeutic activity, monitoring of drug release, as well as delivery of drugs to targeted tissues. The marvelous extent of research has been converged on the pharmaceutical applications of ionic liquids (ILs) due to their high drug dissolution and expeditious drug delivery potential. Local anesthetic-based asset of lidocaine is of profound interest as biologically active cation of the ionic liquids due to its high pharmacological profile. Lidocaine-based ILs have been explored so far for their various synthetic methods as well as physicochemical profile. Being pharmacologically crucial, lidocaine-based ionic liquids as well as deep eutectic solvents (DESs) have been utilized in dermal anesthesia, skin permeation, transdermal drug delivery, wound dressing as well as topical drug delivery. Clinical trials also proved them efficient for oral mucositis. This review is first of its kind to cover all the lab and clinical progresses made so far for these significant ionic liquids.