Audiovisual distraction (AVD) is one of the non-pharmacological means of anxiety prevention. However, few studies have evaluated its perioperative effect in adults. To evaluate the contribution of audio-visual distraction in the prevention of perioperative anxiety in adult patients proposed for surgery under spinal anesthesia. This was a prospective randomized controlled study lasting three months from July 1, 2021. We included ASA I to III over 18 years patients, proposed for visceral or orthopedic surgery under spinal anesthesia. We didn't include patients operated in lateral or prone positions or with a history of anxiety disorders or communication difficulties. 90 patients were randomized into two groups: a control group T and a group A who had an AVD throughout the operation. The primary outcome was anxiety as assessed by the visual analogue scale (VAS). Demographic characteristics, Amsterdam preoperative anxiety and information scale (APAIS) and pain levels were comparable between the two groups. During the surgery, 22 (48.9 %) patients in group T versus 3 (6.7 %) in group A required Midazolam (p < 0.001). Anxiety assessed by VAS at the end of the act was lower in group A (p < 0.001). The pain levels also were lower in patients who received AVD (p = 0.004). A patient satisfaction score (Iowa Satisfaction with Anesthesia Scale French version) ≥ 5.4 was more frequently observed in group A (p < 0.001). AVD reduced perioperative anxiety and decreased the use of midazolam during surgery performed under spinal anesthesia.