Background and Aims We report a challenging case of 40 yr old short stature(133cm), malnourished (32kgs) patient who had postpoliomyelitis complications with lower limb contractures and severe kyphoscoliosis and difficult airway presented with abnormal uterine bleeding posted for transabdominal hysterectomy.

Methods We attempted dural puncture at 3 different levels for multiple times under ultrasound guidance but was not successful.So as a plan B, we identified caudal epidural space under ultrasound guidance and catheter threaded and fixed for continuous caudal anaesthesia. After giving 12 ml of 0.25% of bupivacaine in incremental doses over 15 mins,achieved T6 sensory block. Surgery completed in 1 hr. Intraoperative period was uneventfull.

Results T6 sensory level block achieved with 12 ml of 0.25% bupivacaine given through caudal epidural catheter,which lasted for 120 mins.

Conclusions Caudal epidural anaesthesia can bea good choice in patients with severe vertebral column anamolies where we could not achieve central neuraxial block at lumbar levels.