90 pediatric patients undergoing lower-extremity orthopaedic surgery with caudal epidural nerve blocks were randomized to one of three groups: (1) adjuvant intravenous dexamethasone, (2) adjuvant caudal epidural dexamethasone, and (3) placebo (saline). The purpose of this trial was to determine the effect of dexamethasone on postoperative analgesia and vomiting. The results of this study demonstrated that both dexamethasone groups had a significant increase in the duration of analgesia, a lower number of analgesic doses, a reduction in the total amount of paracetamol, and a lower incidence of post-operative emesis when compared to placebo. Three-way comparisons also demonstrated significant differences between groups in pain scores over 24 hours.