Background; Many hand surgeons are moving away from traditional surgery using a tourniquet and sedation to an approach that utilizes wide-awake local anesthesia and no tourniquet (WALANT).  The Primary aim of this study was to evaluate and compare the effect of WALANT technique versus local intravenous anaesthesia in hand surgery regarding patient comfort and time of surgery. The secondary aim of this study was provide safe and effective anaesthesia and analgesia for patient undergoing hand surgery without the need to perform general anesthesia and decreasing hospital stay. Methods: This study was performed in Minia university hospital. After taking informed consent, 100 Patients undergoing hand surgry were enrolled in the study based on inclusion and exclusion criteria. For patients who met eligibility criteria, the study physician performed anaesthesia using either methods included in the study (WALANT technique or conscious sedation).  Patients were randomized into two groups. Both the patients and investigators were aware of the procedures conducted. Result: Blood loss was significantly higher in WALANT group compared to conscious sedation group (p< 0.001). The mean VAS score in WALANT group was 3.68± 1.79 and ranged from 0 to 8 while the in conscious sedation group it ranged from 4 to 10 with mean± SD was 6.94± 1.24. VAS score was significantly lower in WALANT group compared to conscious sedation group (p= 0.001). Conclusion: The WALANT technique was more effective than conscious sedation in relation to pain control. WALANT procedure was associated with lower discomfort (VAS score) among study participants.