We present the result of the interest in using ultrasound guidance release of carpal tunnel syndrome associated with WALANT anesthesia and office setting in terms of quality of care and patient experience. We have compared 3 pathways with 30 patients in each. Our results showed the same level of safety of the ultrasound guidance technique compared to the Agee technique. We also showed an improved satisfaction of the patient for ultrasound guidance under WALANT and office settings compared to the other pathways. The management of carpal tunnel syndrome by ultrasound guidance surgery under WALANT appears to increase satisfaction rates and perception of anesthesia quality, compared with endoscopic management under LRA. These results were also considerably improved in an office surgery setting compared with a conventional operating room.