One hundred thirty-nine patients with carpal tunnel syndrome undergoing carpal tunnel release were randomized to receive either lidocaine alone (n=67) or a combination of lidocaine and bupivacaine (n=72). The primary outcome was postoperative pain severity measured over 72 hours. Secondary outcomes included time to first analgesic use, quantity of analgesics consumed, and duration of postoperative finger numbness. Pain scores were significantly lower in the intervention group at 6 hours (2.3 vs. 3.2, p<0.05) and 8 hours (2.9 vs. 3.9, p<0.05). Patients receiving the combination anesthetic also delayed taking their first analgesic longer (5.2 vs. 3.7 hours, p<0.05). However, this group experienced prolonged numbness at nearly all time points. Overall, the study revealed that the addition of bupivacaine modestly improved early postoperative pain control but at the cost of extended finger numbness. This suggests that patient and surgeon preference should guide anesthetic selection.