Inclusion Criteria:  Age between ( 18 - 45 ) years. Body mass index between ( 18.5 - 35 ) patients undergoing perineal surgery as anal fissure , piles and rectocele patients receiving bupivacaine ( 20 mg / 4 ml ) as spinal anesthesia Patinets with physical status 1 or 2 according to ASA classification  Exclusion Criteria:  Patient refusal . Any contraindication of neuraxial block as : coagulopathy , skin infection at injection site or bacteremia , hypovolemia and shock , history of allergy to L.A , sever aortic stenosis or mitral stenosis ……… etc Patients with physical status other than 1 and 2 according to ASA classification Those with history of nausea and vomiting , also those who received anti emetic drugs in last 2 hours of operation . Allergy to any of the drug included in this study .