Wide-awake local anaesthesia with no tourniquet has gained popularity in hand surgery because it can simplify care, reduce anaesthetic requirements and allow intraoperative assessment of tendon function. This randomized clinical trial compared WALANT with forearm tourniquet Bier block anaesthesia for minor hand procedures. Both techniques provided effective anaesthesia, supporting WALANT as a practical alternative in appropriately selected patients. The broader value of the study is operational as well as clinical: WALANT can reduce dependence on operating-room resources and may improve workflow for procedures that do not require general or regional anaesthesia. Patient selection remains important, particularly in individuals with anxiety, intolerance of an awake procedure or complex surgery. The evidence also supports the basic safety principle behind WALANT—careful dosing, appropriate patient monitoring and familiarity with local anaesthetic technique. For HCPs, the message is that the traditional assumption that a tourniquet-based block is required for minor hand surgery is increasingly difficult to justify universally. WALANT can be incorporated into a day-surgery pathway when the procedure, patient and surgical team are all suited to the approach.