Purpose of review: This is a short review describing recent data on the use of opioids in epidural anesthesia on abdominal surgery. It is known that postoperative pain has nociceptive, inflammatory and neuropathic components and must be prevented. The period following abdominal surgery is particularly challenging because it has other side effects related to the surgery, in addition to pain. Limiting these unwanted consequences requires a multidisciplinary team. Opioids remain the leading postoperative pain management drugs despite their known side effects, which are dose-dependent and may vary according to the route of administration. Sedation, dizziness, nausea, vomiting, and constipation are often related to opioid use. Since constipation or ileum are also directly related to abdominal surgery, temporary changes in gastrointestinal motility are inevitable after open surgeries. As such, there is concern that opioid-based anesthesia could make it worse and even increase postoperative morbidity and mortality. Recent findings:Several studies involving open colorectal surgery have shown that epidural analgesia, with or without opioid administration, is more effective in treating postoperative pain than intravenous analgesia, thus, this article intends to conduct a literature review to assess whether the association of opioids and local anesthetics in epidural analgesia for colorectal surgery increases the incidence and intensity of postoperative ileus.Summary: This review found no convincing evidence that the use of intrathecal opioids increases the incidence of postoperative ileus, in addition, it was shown to be an effective pain management tool, as expected.