These updated guidelines focus on the management of all patients receiving epidural or spinal opioids in in-patient (e.g. operating rooms, intensive care units, labour and delivery suites, post-operative surgical floors, hospital wards) or ambulatory (e.g. stand-alone outpatient facilities) settings. These guidelines do not apply to patients with chronic or cancer pain (except those with acute postoperative pain), patients with pre-existing implantable drug delivery systems, or patients with contra-indications to spinal or epidural opioids (e.g. coagulopathy, sepsis).