Abstract: Anxiety is the commonest anticipated problem of patients during the perioperative period. Preoperative anxiety can produce poor postoperative outcome and make the management and control of postoperative pain more difficult. Studies have demonstrated a strong relationship between anxiety and pain. Anxiety leads to elevated pain, likewise pain results in an increased level of anxiety. Therefore, it can be postulated that reducing the amount of anxiety experienced preoperatively with an anxiolytic will reduce the burden of pain experienced by patients postoperatively. This study assessed the clinical effect of preoperative anxiolysis with Lorazepam on postoperative pain perception in patients undergoing elective lower limb major orthopaedic surgeries under combined spinal epidural (CSE) anaesthesia. This was a prospective study of 122 patients who presented for surgeries at the University of Abuja Teaching Hospital, Nigeria. Patients were randomly assigned to receive either Lorazepam 2mg (n=56) or placebo (n=56) the night before surgery and 2h before scheduled surgery. Postoperative pain scores, analgesic requirements and satisfaction with pain control were evaluated during the first 24h following surgery.We found that patients who received Lorazepam reported a significantly lower pain score than placebo group during the first12h (p= 0.031) while morphine requirement was significantly greater in the placebo group than Lorazepam group (8.20±1.91mg vs 14.8 ±2.10mg; p= 0.036) and patients treated with anxiolytics showed a greater satisfaction with pain relief (p=0.0185). In summary, preoperative Lorazepam produced significant anxiolysis that led to reduced pain, lower analgesic consumption, and better satisfaction but with modest side effects.