Spinal anaesthesia-induced hypotension (SAIH) is a common complication, with incidence rates varying widely depending on patient factors and definitions used. This article reviews the pathophysiology, prevention, and management strategies for SAIH. The loss of sympathetic tone due to spinal anaesthesia leads to venous pooling, decreased venous return, and reduced cardiac output. Reflex mechanisms, such as the Bezold-Jarisch reflex, may exacerbate hypotension. Risk factors include hypovolemia, autonomic dysfunction, obesity, and prolonged fasting. Preventive strategies include fluid co-loading, vasopressor infusions, and lower limb compression. Low-dose spinal techniques, unilateral spinal anaesthesia, and combined spinal-epidural approaches help minimize risk. Treatment involves early recognition, judicious fluid administration, vasopressor use, and avoiding excessive sedation to maintain cardiovascular stability.