Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) offers a safe, cost-effective, and patient-friendly alternative to traditional anesthesia in hand and wrist surgeries by eliminating tourniquet discomfort and anesthetic risks. This study aimed to evaluate the effectiveness and safety of WALANT as a sole anesthetic technique in elective hand and wrist procedures. Methods: This prospective study was conducted on 50 American Society of Anesthesiologists (ASA) I–III patients undergoing elective hand or wrist surgery at Benha University Hospital. All patients received lidocaine with epinephrine without tourniquet application. Pain (Visual Analogue Scale [VAS]), analgesic use, complications, and satisfaction were assessed up to 24 hours postoperatively. Results: The median onset of sensory block was 4 ± 1 minutes. Open procedures represented 56% of cases. Median VAS pain scores rose from 1 immediately post-surgery to 4 at 24 hours (p