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Objectives To evaluate the knowledge, attitude and practice (KAP) of thoracic segmental spinal anaesthesia (TSSA) among Indian anaesthesiologists and to identify barriers to its clinical adoption.Design A cross-sectional survey was conducted among Indian anaesthesiologists practising in different academic institutions, government bodies and private practices.Setting The online questionnaire was disseminated electronically through professional associations of Indian anaesthesiologists and social media platforms.Participants A total of 381 anaesthesiologists representing academic institutions, government hospitals and private practice settings.Interventions This observational survey included a structured five-section electronic questionnaire covering demographics, knowledge (10-point scale), attitudes (5-point Likert scale) and clinical practice patterns. The tool was piloted, expert-reviewed and showed acceptable internal consistency.Main outcome measures Knowledge scores (good, average, poor), attitude, percentage of practitioners routinely using TSSA and identification of statistically significant factors (p<0.05) associated with its practice. Some key barriers were identified.Results A total of 381 responses were obtained from the participants (mean age 47.53±10.4 years; 58.5% male; 57.2% with >15 years’ experience; 60.4% private practitioners). Knowledge scores were promising, with 66.4% showing adequate understanding of TSSA’s indications, technique and safety. The majority of participants exhibited a positive attitude towards incorporating TSSA into clinical practice. However, only 32.3% reported routinely practising TSSA, although 68.2% had performed TSSA at least once, most commonly for laparoscopic cholecystectomy. A significant association was observed between the participating anaesthesiologists and their gender (p=0.03), years of experience (p=0.04), workplace (p=0.001), knowledge score (p=0.047) and previous TSSA training (p<0.001). Key barriers included limited training opportunities, concerns over complications and institutional reluctance. Hands-on workshops were the most desired support for wider adoption (59.3%).Conclusions Although knowledge and attitudes towards TSSA are generally favourable among Indian anaesthesiologists, practical adoption remains limited. High-level evidence, structured training programmes and guideline dissemination may facilitate wider acceptance of TSSA in Indian anaesthesia practice.