This review covers literature relating to the use of spinal and epidural opioids. The analgesic effect of epidural and spinal opioids is compared with analgesia obtained from other routes of administration. Means of enhancing the analgesic effect with other drugs—most importantly the α2-agonists—and preventing side effects with opioid antagonists are considered. The review also draws attention to the use of pethidine as a local anaesthetic and notes reports of complications from epidural or spinal administration of opioids.