Desmet 2013.

Methods	Parallel group RCT.
Participants	In Belguim, 150 participants greater than 18 years undergoing arthroscopic shoulder surgery with interscalene block were included. Participants less than 18 years old, those with diabetes, brachial plexus neuropathies, severe bronchopulmonary disease, systemic glucocorticoid use, pregnancy, routine use of opioids or sensitivity to any of the study drugs were excluded.
Interventions	Block All participants underwent nerve stimulator‐guided interscalene block with ropivacaine 0.5% 30 ml. Dexamethasone/placebo Dexamethasone group: dexamethasone 10 mg perineurally and normal saline 2 ml intravenously. Intravenous dexamethasone group: normal saline 2 ml perineurally and dexamethasone 10 mg intravenously. Placebo group: normal saline 2 ml perineurally and normal saline 2 ml intravenously. Intraoperative anaesthesia/analgesia General anaesthesia was induced with target‐controlled propofol infusion 3‐5 micrograms/ml, remifentanil (loading dose 1 microgram/kg, continuous infusion 0.05‐0.3 microgram/kg/min) and cisatracurium 0.5 mg/kg. Postoperative analgesia Paracetamol was administered for VRS more than 2 on a 5‐point VRS. Diclofenac IV 50 mg was administered for inadequate analgesia with paracetamol. Piritramide IM 15‐20 mg was administered as needed.
Outcomes	Outcomes of interest for the review Duration of sensory block defined as the time between performance of the block and the time to first analgesic request. Participant satisfaction measured on a 2‐point scale. Other outcomes Number of participants experiencing moderate to severe pain. Mean postoperative paracetamol consumption. Postoperative blood glucose concentrations.
Notes	Funding: no information provided. Conflicts of interest: none.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random sequence was computer‐generated.
Allocation concealment (selection bias)	Low risk	Allocation was concealed in sealed, opaque envelopes.
Blinding of participants (detection bias)	Unclear risk	No indication whether participants were blinded.
Blinding of personnel (detection bias)	Unclear risk	Assume operating room personnel were blinded since study drugs prepared by staff member not involved int he study and delivered in unidentifiable syringes, however, no indication whether other personnel were blinded (surgeon, recovery room and ward nurses) was blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Only four participants were excluded from the placebo group.
Selective reporting (reporting bias)	Low risk	No protocol available. All outcomes reported as stated in the methods section.
Other bias	Low risk	Appears to be free of any other bias.