A 30-year-old female patient (38 wk pregnant, single pregnancy) underwent cesarean section. After the surgery, the anesthesiologist found it difficult to remove the epidural catheter. The pregnant patient was placed in a right lateral tilt position. The midline puncture through the L2-3 intervertebral space was executed, but the medical staff encountered resistance after several needle direction adjustments. An alternate paramedian puncture technique was used, resulting in reduced resistance. A sensation of ligamentum flavum penetration was experienced at a depth of approximately 7 cm. A negative pressure test confirmed the entry of the epidural puncture needle into the epidural space. Subsequently, a spinal needle was inserted through the epidural needle, resulting in a sensation of dura mater puncture without evidence of nerve stimulation. Clear cerebrospinal fluid flow was observed and 1.8 mL of 0.5% ropivacaine was administered slowly. After removing the spinal needle, the left hand of the anesthesiologist held in place the epidural puncture needle, and an enhanced epidural catheter (MaiChuang Medical, Jiangsu Province, China) was advanced with the right hand until the 15 cm scale. The epidural puncture needle was retracted using the left hand, ensuring that the catheter was retreated outward of the skin to the 12 cm scale, leaving the catheter positioned at a length of 5 cm in the epidural cavity. The catheter was smoothly inserted, and no blood or cerebrospinal fluid was observed upon syringe withdrawal. The patency of the catheter was good, as demonstrated by the physiological saline test. The exposed end of the catheter was fixed to the patient's back using adhesive tape. The anesthesia administered during the surgery was effective, and the procedure was conducted smoothly. Ten minutes before the conclusion of the operation, the injection of the initial dose of analgesia through the epidural catheter failed due to significant resistance during administration. Preliminary speculation suggested that a section of the catheter might have formed a knot under pressure on the patient's back. However, no knots were observed in the catheter after the surgery. The patient’s position was adjusted to a right lateral tilt, but an attempt to remove the catheter was unsuccessful. The patient did not experience any pain or abnormal sensations during the catheter traction process. Consequently, a decision was reached to postpone the catheter removal. The exposed portion of the catheter was disinfected, dressed, and secured. Intravenous analgesia was administered as an alternative. With the consent of the patient and her family, an emergency computed tomography (CT) examination was performed, revealing a tight knot in the catheter at the right subvertebral notch of the L2 vertebra. Evaluation using the spinal model showed that placing the patient in a left lateral position with the left lower limb extended and the right lower limb flexed at a 90-degree angle allowed the anesthesiologist to apply pressure on the patient's right scapula, pushing it backward and downward with the left hand. Simultaneously, the anesthesiologist applied pressure to the patient's right hip joint, pushing it forward with the right hand. This maneuver effectively "spiraled" and separated the small joints of the spine. A careful attempt was made at the bedside to remove the catheter by using this method with the consent of the patient and her family. The catheter was gently pulled with a constant force. Despite encountering resistance, the catheter was successfully removed. The patient did not experience pain or abnormal sensations during the removal process. Examination of the catheter showed that a knot had formed approximately 3.2 cm from the catheter tip. Additionally, the inner wire coil of the catheter had significantly elongated under continual tension, and the outer part of the catheter coil, located 8 cm from the tip, had fractured, leaving an intact end. The patient was monitored for 1 wk following catheter removal, and no adverse complaints or complications were reported. The patient had a history of ectopic pregnancy three years ago, and the ectopic pregnancy lesions were removed under laparoscopy. The patient had good living habits and denied any family history of disease or other genetic diseases. The vital signs of the patient were as follows: Body temperature, 36.8 °C; heart rate, 89/min; respiratory rate, 18/min; blood pressure, 138/86 mmHg; weight, 80 kg; and height, 154 cm. The patient’s platelet count was 132 109, thrombin time was 16 s, prothrombin time was 10.4 s, fibrinogen was 3.85 g/L, and activated partial thromboplastin time ratio was 0.98. The preoperative electrocardiogram was normal. Emergency CT examination after the operation showed that the catheter had a tight knot at the right subvertebral notch of the L2 vertebra.