Yadov 2008.

Methods	Parallel group RCT.
Participants	In Nepal, 60 ASA I‐II participants undergoing forearm or hand surgery with brachial plexus block were included. Participants with uncontrolled hypertension, Ischaemic heart disease, acid peptic disease, neurological, psychiatric neuromuscular or respiratory disorder, drug addiction, pregnant or lactating women were excluded.
Interventions	Block All participants underwent nerve stimulator‐guided brachial plexus block with lignocaine (1.5%) and adrenaline (1:200,000) 24 ml. Dexamethasone/placebo Dexamethasone group: dexamethasone 4 mg perineurally. Placebo group: nerve block only. Intraoperative anaesthesia/analgesia None described. Postoperative analgesia Diclofenac (by mouth) 50 mg was administered if VAS was 3‐5. Diclofenac IV 75 mg was administered if VAS was 6 or greater.
Outcomes	Outcomes of interest for the review Intensity of postoperative pain on 11‐point VAS and 12 hours after surgery. Duration of analgesia defined as the time between onset of analgesia to first pain perception by the patient. Postoperative nausea and vomiting. Other outcomes Intensity of pain measured on VAS at 1 min, 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 6 hours after surgery. Postoperative analgesic consumption (non‐opioid). Surgeons satisfaction score measured on an 11‐point VAS.
Notes	This is a three‐arm study of 90 participants. In group B (30 participants) neostigmine 0.5 mg was added to the block solution, however this is not an outcome of interest for this review and this group was not included in any of the analyses. Funding: no information provided. Conflicts of interest: no information provided.
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)	Unclear risk	No indication of how group allocation was concealed.
Blinding of participants (detection bias)	Unclear risk	No indication whether participants were blinded.
Blinding of personnel (detection bias)	Unclear risk	Assume anaesthesiologist performing the block was blinded since study drugs were prepared by an anaesthesiologist not involved in the study, however no indication whether other 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	No missing outcome data.
Selective reporting (reporting bias)	High risk	No protocol available. The authors report mean and SD for all outcomes except pain scores.
Other bias	Low risk	Appears to be free of any other bias.

ASA = Americal Anesthesiology Society; BMI = body mass index; IM = intramuscularly; IV = intravenously; kg = kilograms; MAC = maximum alveolar concentration; mg = milligrams; ml = millilitres; mm = millimetres; NRS = Numerical Rating Scale; PACU = Postanaesthesia care unit; PONV = postoperative nausea and vomiting; RCT = randomized controlled trial; SD = standard deviation; VAS = Visual Analalogue Scale; VRS = Verbal Rating Scale.