Kawanishi 2014.

Methods	Parallel group RCT.
Participants	In Japan, 39 participants aged 20 and 75 years undergoing arthroscopic shoulder surgery with interscalene block. Participants with coagulation disorder, skin infection at site of surgery, preexisting neuropathy involving upper limb, drug dependency, systemic opioid use within the previous six months, peptic ulcer disease, diabetes mellitus, renal or hepatic disease or pregnancy were excluded.
Interventions	Block All participants underwent ultrasound‐guided interscalene block with ropivacaine 0.5% 20 ml after the surgical procedure. Dexamethasone/placebo Dexamethasone group: dexamethasone 4 mg perineurally. Placebo group: dexamethasone 4 mg intravenously. Intraoperative anaesthesia/analgesia Anaesthesia was induced and maintained by propofol 1mg/kg, remifentanil infusion 0.1 ‐0.3 microgram/kg/min, rocuronium 0.7 mg/kg and sevoflurane 1.0‐1.5 minimum alveolar concentration. Morphine 5 mg was administered after induction of anaesthesia. Postoperative analgesia Flurbiprofen IV was administered in the recovery room. Loxoprofen (by mouth) was administered after discharge from recovery room. Participants were instructed to request analgesia as soon as pain developed.
Outcomes	Outcomes of interest for the review Intensity of postoperative pain measured on an 11‐point NRS the morning after surgery. Duration of sensory block defined as the interval between the time the block was performed and the first analgesic administration. Incidence of sleep disturbances measured on a 2‐point scale. Participant satisfaction measured on a 5‐point scale. Incidence of adverse events including nausea and vomiting, interscalene site infection, redness or neuropathy.
Notes	Funding: no information provided. Conflicts of interest: none.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No indication of how random sequence was generated.
Allocation concealment (selection bias)	Low risk	Treatment allocation was concealed by closed envelopes.
Blinding of participants (detection bias)	Unclear risk	No indication whether participants were blinded.
Blinding of personnel (detection bias)	Unclear risk	No indication whether personnel were blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No indication whether outcome assessors were blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Three participants were excluded in the intravenous group, one in the placebo group and one in the perineural dexamethasone group.
Selective reporting (reporting bias)	High risk	There was an outlier in the intravenous dexamethasone group that was not included in the analysis.
Other bias	Low risk	Appears to be free of any other bias.