One hundred four patients with elective wrist/hand surgery under supraclavicular block were randomized to intravenous dexamethasone 10 mg (n=37), combined perineural 5 mg + intravenous 5 mg dexamethasone (n=34), or placebo (n=33). The primary outcome was sensory block duration. Secondary outcomes included motor block duration; rebound pain 2 h after first pain; worst pain at 8, 16, 24, 32, 40, and 48 h; opioid consumption (0–24 h, 25–48 h); nausea/vomiting; burning sensation; sleep disturbance; and satisfaction. Outcomes were tracked to 48 h with standardized perioperative analgesia. Overall, the results revealed no difference between the two dexamethasone regimens for the primary or secondary outcomes, while both dexamethasone groups outperformed placebo for longer sensory block, lower 24-h pain, less rebound pain, and reduced early opioid use. In short, intravenous dexamethasone alone was sufficient; combining perineural with systemic dosing did not add benefit.