Achondroplasia is an inherited skeletal disorder affecting 
bone growth and development.  It presents the most 
common cause of dwarfism in humans. Associated 
anatomical and physiological changes present a major 
challenge to management of both general and regional 
anaesthesia. This case report describes our anaesthetic 
management of elective caesarean delivery in an 
achondroplastic dwarf. In this challenging patient group, we 
discuss the risks and benefits of different anaesthetic 
approaches, the safe use of epidural anaesthesia with 
ultrasound guidance, sacral sparing following successful 
epidural catheter insertion, and epidural opioids for post
operative analgesia. This is followed by a review of the 
literature.