Background: The use of patient-controlled analgesia (PCA) has increased in recent years. Data regarding PCA’s usefulness following anorectal surgery are equivocal, and it still needs to be further studied and discussed. Therefore, the current study was conducted to compare PCA with pudendal nerve block (PNB) for pain management in patients undergoing anorectal surgery. Methods: Patients candidate for elective anorectal surgery under general anaesthesia were considered eligible. Prior to the surgery, the patients were divided into PCA and PNB groups. PNB was performed at the end of the surgery just before extubation. PCA was initiated in the recovery room. The patients’ pain scores were recorded based on an 11-point numerical rating scale (NRS) at 2, 6, 12, and 24 hours into the post-operative period. The total dose of morphine sulfate consumed, the overall satisfaction, and any side effects were recorded. Results: 100 patients with a mean age of 44.55 ± 11.45 years were enrolled (71% male). Both methods resulted in effective pain control. The difference in the consumed doses of morphine was not statistically significant (P = 0.2). The PNB group patients were more satisfied than those in the PCA group (8.6 ± 1.9 vs. 7.3 ± 2.2; P = 0.037). The recorded side effects were significantly higher in the PCA group (P < 0.001). Conclusions: Although both morphine-contained PCA and PNB with Marcaine resulted in effective pain control following anorectal surgery, it is likely that local anaesthesia with Marcaine is accompanied by fewer side effects and more satisfaction.