Background and aims Shoulder surgery is associated with severe pain. Pain delays rehabilitation and lowers quality of life. Finding adjuvants to the LA to improve analgesia and facilitate mobilization has been the focus of researchers recently. The aim of this work was to investigate which administration methods—dexamethasone perineural or intravenously—prevents pain more effectively.

Methods Prospective, randomized study conducted at Hospital of Traumatology and Orthopaedics after ethics committee approval. Study involved 75 patients with upper limb fracture or shoulder joint surgery in RA and GA.

Group I: Bupivacaine 0.25% 70 mg + Dexamethasone 8 mg perineurally

Group II: Bupivacaine 0.25% 70 mg perineuraly + Dexamethasone 8 mg i/v.

Group 0 (control): Bupivacaine 0.25% 70 mg perineurally

The following indicators were fixed: pain intensity, morphine consumption, patient satisfaction.

Statistical analysis was performed using SPSS software.

Results Pain reliably (p<0.05) differed on D0 at all times. Pain was significantly lower in I and II groups comparing to the control group. There was significant difference in pain intensity between groups I and II in favor of the intravenous group (p<0.05).

The mean morphine consumption for the control group on D0 was significantly higher for Group 0: 26.4 mg, I -15.6 mg and 13.2 mg for group II (p<0.05).

In the control group, at first night, sleep disorders were more frequent (72.0%), but in group I only 12.0% and 4% in group II (p<0.05).

Conclusions The pain intensity and opioid is significantly lower in the dexamethasone groups, especially if systemically given. Postoperative period quality is significantly higher in dexamethasone groups.