Background: : Laparoscopic hysterectomy is a standard gynecological surgical treatment used to treat a variety of gynecological conditions. We aimed to evaluate the efficacy and safety of adding two different doses of intraperitoneal dexamethasone to bupivacaine versus bupivacaine alone for postoperative analgesia after laparoscopic hysterectomy. Methods: This randomized trial included 87 females who were scheduled for elective laparoscopic hysterectomy. Patients were randomly allocated into three equal groups: group I; received bupivacaine 100 ml 0.25% + 5 ml normal saline, group II; received bupivacaine 100 ml 0.25% + 4 mg dexamethasone (1 ml) + saline 4 ml, and group III; received bupivacaine 100 ml 0.25% + 8 mg dexamethasone (2 ml) + saline 3 ml. All patients were monitored with a 5-lead electrocardiogram, pulse oximeter, and non-invasive automated blood pressure as they arrived in the operation room. Results: Time of the 1st rescue analgesic requirement was significantly delayed in group III compared to group I and group II (P<0.05) and was significantly delayed in group II compared to group I (P=0.011). Nalbuphine in the 1st 24 hrs was significantly lower in in group III compared to group I and group II (P<0.05) and was significantly lower in group II compared to group I (P=0.003). Conclusions: Addition of either 4 mg or 8 mg of dexamethasone to bupivacaine (0.25%) significantly can prolong the time of first rescue analgesic requirement and reduce postoperative pain and the total consumption of rescue analgesic in 24 h in addition to reduce incidence of postoperative nausea and vomiting.