There are many approaches to pain control in reduction mammaplasty. Preoperative bupivacaine regional blocks control pain relatively inexpensively ($0.07/mL), but last only 8-hours. A liposomal bupivacaine formulation lasts 72-hours but can be costly ($17.21/mL). Orthopedic and thoracic surgeries have demonstrated that dexamethasone ($0.44/mL) plus bupivacaine can prolong analgesia. We conducted a double-blind, randomized controlled trial to determine if dexamethasone plus bupivacaine regional block improves postoperative pain control, reduces inpatient narcotic usage, and improves patient satisfaction (ClinicalTrials.gov NCT04919317).