Fifty-seven patients scheduled for hand surgery were randomized to receive either infraclavicular brachial plexus block (ICB) or wide-awake local anesthesia with no tourniquet (WALANT). Patients unable to tolerate the assigned technique were excluded. The primary outcomes were perioperative pain (VAS) and patient satisfaction. Secondary outcomes included anesthesia application time, onset and total duration of anesthesia, intra- and postoperative analgesic requirements, surgical duration, length of hospital stay, complications, and total cost. Overall, the results showed that pain scores and patient satisfaction were similar between WALANT and ICB. However, WALANT was associated with significantly shorter anesthesia application time, faster onset, shorter total anesthesia duration, shorter postoperative hospital stay, and substantially lower cost. These findings indicate that WALANT offers comparable analgesia and satisfaction with superior efficiency and cost-effectiveness for ambulatory hand surgery.