Objective. Assessment of the efficacy and safety of epidural morphine in patients with severe concomitant injury. Material and methods. 70 patients with severe combined injury (17–45 points for ISS) were divided into two groups: in group 1 ( n = 37), 2 mg of morphine was administered epidurally followed by morphine infusion 0.4 mg / h, in the 2nd group ( n = 33), intravenous administration of fentanyl was used at a rate of 50–100 μg / h. The level of pain syndrome was assessed by a 10-point visual analogue scale (VAS). The mean arterial pressure (MAP) and heart rate (HR) at rest and with activation were recorded, the gas composition of the blood (pH, SaO 2 , PaCO 2 ) was measured, and the vital capacity (VC) was measured. The evaluation of delirium was carried out according to the RASS and CAM-ICU scales. In addition, they recorded the frequency of itching. Results. The intensity of a pain syndrome at rest was more expressed at patients of the 2nd group ( p < 0.05). Against the background of activation of 10,8% of patients of the 1st group and 36,4% of patients of the 2nd group experienced a pain syndrome intensity of 4–7 points on VAS. In patients of the 2nd group, with activation, there was an increase ( p < 0.05) in the indices of MAP and HR. VC in patients of the 1st group was 45.4 ± 5.8%, in the 2nd – 41.3 ± 4.7% ( p < 0.005). Patients of the 1st group had a lower level of PaCO2 ( p < 0.05) compared with the 2nd group. Postoperative delirium developed in the 1st group in 16.2%, in the 2nd – in 30.3% of patients ( p < 0.05). Pruritus occurred in the 1st group at 21.6% and was absent in the group with systemic administration of opioids. Opioid-induced ileus, nausea and vomiting in the 1st group were not recorded, in the 2nd group were noted in 18.2% and in 9.1% of cases ( p < 0.05), respectively. Conclusion. The use of epidural morphine in patients with severe traumatic injury effective pain relief was observed, not accompanied by of the respiratory depression and changes in blood gas composition. Epidural administration of morphine in patients undergoing massive blood loss and hemorrhagic shock was not accompanied by arterial hypotension. Effective anesthesia contributed to reducing the incidence of postoperative complications.