Eighty-three patients with well-controlled type-2 diabetes mellitus undergoing primary total knee arthroplasty were randomized to receive either intravenous dexamethasone (n=42) or placebo (n=41). The primary outcome was postoperative blood glucose levels. Secondary outcomes included insulin requirements, postoperative pain (at rest and during activity), and postoperative nausea and vomiting (PONV). Outcomes were assessed from the day of surgery through postoperative day 5. Overall, the results of the study revealed that IV dexamethasone transiently increased blood glucose levels and insulin requirements on postoperative day 1 but returned to baseline by day 3. Dexamethasone also reduced early postoperative pain through day 3 without significantly impacting PONV. These findings suggest IV dexamethasone offers analgesic benefit with manageable glycemic effects in diabetic patients undergoing TKA.