Ninety patients undergoing total hip arthroplasty via direct anterior approach with neuraxial anesthesia were randomized to receive either a single dose of 10 mg dexamethasone IV (n=45) or a placebo (isotonic saline IV) (n=45) intra-operatively. The primary outcome of interest was pain level measured through a visual analog score (VAS) at 1, 3, 6, 12, and 24 hours post-operatively; opioid use measured as the sum of morphine equivalents (MME); and range of motion (ROM) 24 hours post-operatively. Secondary outcomes included the time-up-and-go (TUG) test and in-hospital complications. Outcomes were assessed up to 24 hours post-operatively. Overall, the results of the study revealed that the dexamethasone group reported significantly lower opioid use (P<0.01) and VAS scores at 6 and 12 hours post-operative (P=0.02 and P=0.01, respectively). There were no significant differences in ROM, TUG test results, or complications between the groups. The findings suggest that intra-operative dexamethasone effectively reduces postoperative pain and opioid use without adverse effects.