This study aimed to determine the effects of music and active noise cancellation on intraoperative anxiety in patients undergoing lower limb surgeries under spinal anaesthesia. After obtaining ethical approval, this randomised controlled study was conducted in adult patients (18-50 years of age) of either gender. Patients were randomly allocated to binaural beat music (Group A), noise cancellation (Group B) or no headphones (Group C) group (n = 36 in each group). State-Trait Anxiety Inventory-6 (STAI-6) score and Visual Analogue Score for Satisfaction (VAS-S) were noted preoperatively and at the end of surgery. In addition, Ramsay sedation scores and Likert communication difficulty scores were noted at 30 min intraoperatively. Haemodynamic parameters were noted preoperatively and at different intervals intraoperatively till the end of the surgery. There was a significant decrease in anxiety scores in Group A, Group B and Group C with postoperative STAI-6 scores (mean ± standard deviation) of 7.8 ± 1.7, 11.7 ± 4.2 and 14.7 ± 5.3, respectively. The difference was significant in Groups A and B compared to Group C (P < 0.001). Patient satisfaction scores in Groups A and B were better than in Group C (7.3 ± 1.7 and 6.2 ± 1.6 vs. 5.2 ± 1.3, respectively). Sedation scores and communication difficulty was significantly better in Groups A and B compared to Group C. Systolic blood pressure was significantly better intra- and postoperatively. There were no significant differences in other haemodynamic parameters on most occasions. Music and noise-cancellation headphones can reduce anxiety and improve satisfaction and sedation scores in patients undergoing spinal anaesthesia.