Kobe Bryant dropped in 33 points as the Los 101, at New Orleans Arena.
Andrew Bynum added 25 points and 18 rebounds, while Pau Gasol finished with 18 points and 10 boards for Los Angeles, which was coming off a 116-111 double- overtime victory over the Memphis Grizzlies on Tuesday.
Jarrett Jack scored a season-high 30 points with six assists for the Hornets, who have dropped 10 of their last 13 games. Chris Kaman had 21 points and 12 rebounds, but failed to connect on the go-ahead jumper late in regulation, forcing overtime.
The Lakers trailed by as many as 17 in the second quarter and by a score of 54-40 at the break before battling back with a 14-4 run in the third to cut their deficit to 57-62 near the midpoint of the frame.
Kaman's 15-foot jumper got the Hornets' offense back on track and the team's traded buckets over the next four minutes until the Lakers reeled off seven straight points to knot the game at 68 on Matt Barnes' three-pointer within the final minutes of the third.
It was a 70-70 contest entering the fourth quarter and Greivis Vasquez netted five straight points in a 7-0 spurt by the Hornets to jump out to a 77-70 lead.
However, Los Angeles scored the next four points and stayed within two possessions for the remainder of regulation.
After a pair of Jack free throws and a Kaman layup put New Orleans ahead, 93-88, with two minutes left in the fourth, Bynum connected on a short hook shot to close the gap to three.
Jack's driving layup was blocked on the other end, leading to Bryant getting fouled while shooting a three on the Lakers' ensuing touch and he connected on all three foul shots to tie the game at 93 with 19.3 seconds left.
Coming out of a timeout, Kaman received a pass on the right elbow and got off an open jumper, but it rimmed out and Bryant's corner three at the buzzer was also too strong to force the extra period.
A Bynum steal in the opening stages of overtime led to Bryant's three-point play on a fastbreak dunk to give the Lakers their first lead since holding a 17-16 advantage in the first quarter.
New Orleans responded with a 6-2 swing to take a 99-98 lead on Trevor Ariza's long two-pointer with 1:21 remaining in the game, but Los Angeles quickly regained the lead on Derek Fisher's jumper on the other end.
Metta World Peace then stole the ball from Kaman and converted on a running layup to put the Lakers up by three and after Ariza's trey from the right wing was no good, Los Angeles closed the game out on the free-throw line to earn their fourth straight win.
Neither team took a lead larger than four points over a back-and-forth opening eight minutes that saw four lead changes and five ties until the Hornets closed out the opening frame with a 12-3 run that put them ahead, 28-20, after one.
After back-to-back jumpers by Vasquez put the Hornets on top, 36-23, with a little under eight minutes left in the second quarter, Los Angeles responded with an 8-2 spurt to close the gap to seven, 38-31.
New Orleans, though, would answer with six straight points to regain its double-digit lead and pulled ahead by as much as 17 before taking a 54-40 advantage into the break.
Los Angeles improved to 9-14 on the road this season, while New Orleans fell to 4-18 at home...The Hornets have dropped five straight to the Lakers and are 4-13 over the team's last 17 meetings...Fisher finished with 11 points and four assists for Los Angeles...Vasquez netted 15 points for the Hornets...The Lakers went 28-for-35 from the foul line...The Hornets went 10-for-13 from the free-throw line.