I drain most butt pus in either the office or the ER. I tend to let the residents drain it without my supervision in the ER. It is definitely nice to have the ER doc provide some sedation for the big ones. If they are properly trained, there's no reason that the drainage should be inadequate and require a repeat incision.
In the office I just use 1% lido with epi, and the patients seem to tolerate it well, especially when they can appreciate the difference in the two price tags.
I've found that with the appropriate local analgesia, positioning, and the cadence that comes from doing a lot of these, they tend to go smoothly. The only ones I take to the OR are those with a horseshoe or concern for a necrotizing soft tissue infection.
However, I would never say this is the only way to do it. It's just what works best for me, and it's cheaper, so that's nice.
As far as what cases I find fulfilling, it's a mixed bag. I certainly enjoy cancer surgery, which is a big part of my practice, but I also enjoy anorectal procedures quite a bit, with a lateral internal sphincterotomy perhaps being the most cathartic.
If you cure someone's cancer with a laparoscope or robot, they are thankful, and often think highly of you. However, if you cure their butt pain, you are a god in their eyes.....