The study compared the effects of epidural dexamethasone (5 mg) versus methylprednisolone (40 mg) on neuropathic outcomes in parturients with paresthesias during combined spinal-epidural labor analgesia. This is a prospective, randomized, double-blind clinical trial conducted in a Chinese maternity hospital, which included 315 parturients who completed the study. The primary outcome was neurological function at 14 days postpartum, such as impaired skin sensation, decreased muscle strength, or other neurological symptoms. Neurology at 14 days postpartum was not significantly different between groups (p > 0.05). The dexamethasone group had a higher incidence of maternal epidural fever (7.6% vs 2.5%, p < 0.05) and a higher serum interleukin-6 level at 24 hours [15.4 (13.2–17.6) pg/ml vs 2.9, p < 0.05]. There were no significant differences in postpartum hemorrhage, nausea, vomiting, instrumental delivery, NICU admission, or 24-hour CRP level (p > 0.05). The study is registered under ChiCTR2300078866.