Background: Performing anorectal operations under epidural anesthesia has multiple advantages. However, such procedures are associated with severe postoperative pain. Ketamine has previously been described to be a potent local anesthetic adjuvant. Aim of the study: We evaluated if adding ketamine 50mg as an adjuvant to bupivacaine would enhance the postoperative analgesic profile in patients undergoing minor anal surgeries. Patients and methods: One hundred patients scheduled for anal operations were included in this prospective randomized trial, and they were divided into two equal groups; B group (bupivacaine only) and BK group (bupivacaine and ketamine). Results: Both basic and clinical criteria of the included patients were comparable between the two groups. However, ketamine was associated with earlier onset of sensory block (11.3 vs. 15.4 minutes in Group B). Also, the adjuvant was associated with a significant reduction of postoperative pain scores, which was evident four hours after surgery till the end of the first postoperative day. Moreover, the need and the total amount of commenced opioids decreased significantly in Group BK. The incidence of postoperative complications, including pruritis, nausea, and vomiting, was significantly reduced with ketamine administration. Conclusion: Adding ketamine to bupivacaine has multiple advantages in patients undergoing anorectal procedures. It is associated with earlier onset of sensory block, less postoperative pain, and decreased need for postoperative opioids.