Spinal anesthesia is an essential procedure skill for anesthesia practitioners. The technique is featured in all anesthesia textbooks, and it is sufficiently simple so that even “occasional regionalists” use it with success. Observing the spinal anesthetic being administered can give an impression of substantial skills when the procedure is successful on the first attempt.

However, when not successful after a few attempts, and the anatomy is not straightforward, knowing the troubleshooting tips makes a big difference between success and failure. While ultrasound can be used to assist, a difficult back often makes sono-anatomy also difficult and time-inefficient. Dr. Hadzic discusses crucial tips he teaches residents and fellows on how to troubleshoot spinal anesthesia when the needle constantly encounters osseous structures and makes access to the intrathecal space difficult.