Rahangdale 2014.

Methods	Parallel group RCT.
Participants	In the USA, 80 participants aged 18 to 70 years undergoing elective ankle and foot surgery with sciatic nerve block were included. Participants with contraindication to regional anaesthesia, history of allergy to amide local anaesthetics, neurological deficit, coagulopathy, infection, type 1 or 2 diabetes mellitus, systemic use of corticosteroids within six months of surgery, chronic use of opioids, pregnancy and those undergoing midfoot and forefoot surgery were excluded.
Interventions	Block All participants underwent ultrasound‐guided sciatic nerve block with bupivacaine 0.5% with epinephrine 1:300,000 (0.45 mg/kg) Dexamethasone/placebo Perineural dexamethasone group: dexamethasone 8 mg perineurally and normal saline 2 ml intravenously. Intravenous dexamethasone group: normal saline 2 ml perineurally and dexamethasone 8 mg intravenously. Placebo group: normal saline 2 ml perineurally and normal saline 2 ml intravenously. Intraoperative anaesthesia/analgesia Midazolam IV 2‐5 mg was administered to all participants and fentanyl IV 25‐50 micrograms was administered incrementally if necessary before the block. Propofol 25‐75 micrograms/kg/min was administered to provide sedation while maintaining responsiveness to tactile or verbal stimulation after the block. Postoperative analgesia Hydrocodone 10 mg + acetaminophen 325 mg every 4 hours as needed.
Outcomes	Outcomes of interest for the review Intensity of postoperative pain measured on an 11‐point NRS on postoperative day one and day two. Postoperative opioid consumption on postoperative day one and two. Duration of sensory block defined as time to first pain not in saphenous distribution. Duration of motor block defined as time to first toe movement. Incidence of postoperative neurological sequale. Participant satisfaction measured on an 11‐point VAS. Other outcomes Quality of recovery measured by Quality of Recovery‐40 scale. Intensity of pain measured on an 11‐point NRS two weeks after surgery. Postoperative opioid consumption two weeks after surgery.
Notes	Funding: Department of Anesthesiology, Northwestern University. 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	Group allocation was concealed in opaque, sequentially numbered, sealed envelopes.
Blinding of participants (detection bias)	Low risk	No indication that participants were blinded in the paper, however the clincialtrials.gov document states that participants were blinded.
Blinding of personnel (detection bias)	Low risk	No indication that participants were blinded in the paper, however the clincialtrials.gov document states that caregivers were blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessor was blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Number of participants with missing data balanced between groups; three in the intravenous dexamethasone group, one from the placebo group, and none from the perineural dexamethasone group.
Selective reporting (reporting bias)	Low risk	Protocol available on clinicaltrials.gov. All outcomes were reported as stated in the protocol.
Other bias	Low risk	Appears to be free of any other bias.