Objective: Use of Ultrasound (US) to insert spinal needle for administrating Spinal Anaesthesia (SA) is the newer technique with limited literature available about its efficacy and safety. It overcomes the complication raised due to blind technique of SA. Preprocedural US image in elderly patient having technically difficult anatomy has not been studied during SA. Methodology: Two groups received either conventional landmark guided approach SA (group C, n=37) or US guided paramedian approach (group P, n=37) for SA. Technical difficulty assessment and complication rate were recorded during the procedure. Results: Failure rate between both groups (C and P) were (0% vs. 29.7%) respectively. Number of attempts and passes was significantly more in paramedian approach. (p<0.001, p<0.01) Alternative techniques were used in 11 patients in group P. Haemorrhagic tap was noticed in 2 patients in group C and 4 patients in group P. Conclusion: Administrating SA in paramedian approach via US is difficult and increase complication rate. There were several instances where despite good US views of vertebral canal technical difficulty was encountered.