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 postoperative analgesia. This is followed by a review of the literature.