Seventy five patients undergoing anatomic or reverse total shoulder arthroplasty (TSA) were randomized to receive perioperative intravenous dexamethasone (n=43) or no treatment (n=32). The primary outcome of interest was postoperative morphine use over the first 24h postoperatively. Other outcomes of interest included postoperative pain scores, antiemetic use, nausea and vomiting, length of stay and complications. The dexamethasone group demonstrated significantly lower morphine consumption over the first 24h postoperatively. The dexamethasone group also had reduced pain scores at all time points and reduced antiemetic use in the first 4h postoperatively. There was no significant difference in postoperative nausea and vomiting, length of stay or complications.