68 patients scheduled for a carpal tunnel release surgery were randomized to receive distal nerve blockade (median and ulnar nerve) with either a Wide Awake Local Anesthesia No Tourniquet (WALANT) infiltration (n=30) or tourniquet (n=30). The primary outcome of interest was the global perioperative pain score on a Numeric Rating Scale (NRS). Secondary outcomes of interest included visualization scores, success of distal blocks and WALANT, hemostasis quality, patient satisfaction, operative time, and the incidence of adverse events. Patients who received WALANT reported significantly lower pain during the surgery. The visualization was significantly worse, but the WALANT group had a lower need for additional anesthetics, had higher patient satisfaction, and had a lower rate of hematoma at the surgical site.