Release of the transverse carpal ligament can be performed safely under local anesthesia and without the use of tourniquet. There are conflicting reports for the use of tourniquet in carpal tunnel syndrome. The aim of the study was to compare the patient satisfaction with and without tourniquet in patients with carpal tunnel decompression. This was a retrospective study performed in twenty-four patients who underwent bilateral carpal tunnel decompression. All the patients were diagnosed using a combination of clinical history, clinical tests and EMG recordings.One side was operated with use of tourniquet and other side without. Patient evaluation measure was used to assess the satisfaction score. A telephonic interview was conducted and patients were asked the questions regarding discomfort caused by tourniquet. The results demonstrated that there was a significant difference in discomfort at the tourniquet site at the time of operation (p<0.00017). Long term, there was no apparent difference in functional outcome of patients operated on with or without tourniquet. There was also no significant difference in subjective sensation, grip or use of hand in patients who underwent carpal tunnel release with or without tourniquet. We conclude that we should not use tourniquet in carpal tunnel decompression.