Background We have always been searching for the ideal local anesthetic for outpatient spinal anesthesia. Lidocaine has been associated with a high incidence of transient neurological symptoms, and bupivacaine produces sensory and motor blocks of long duration. Preservative-free 2-chloroprocaine (2-CP) seems to be a promising alternative, being a short-acting agent of increasing popularity in recent years. This study was designed to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting. Methods A total of 106 patients were enrolled in this randomized double-blind study. Spinal anesthesia was achieved with 0.75% hyperbaric bupivacaine 7.5 mg (n = 53) or 2% preservative-free 2-CP 40 mg (n = 53). The primary endpoint for the study was the time until reaching eligibility for discharge. Secondary outcomes included the duration of the sensory and motor blocks, the length of stay in the postanesthesia care unit, the time until ambulation, and the time until micturition. Results The average time to discharge readiness was 277 min in the 2-CP group and 353 min in the bupivacaine group, a difference of 76 min (95% confidence interval [CI]: 40 to 112 min; P \ 0.001). The average time for complete regression of the sensory block was 146 min in the 2-CP group and 329 min in the bupivacaine group, a difference of 185 min (95% CI: 159 to 212 min; P \ 0.001). Times to ambulation and micturition were also significantly lower in the 2-CP group. Conclusion Spinal 2-chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal bupivacaine. (ClinicalTrials.gov number, NCT00845962). RésuméContexte Nous sommes depuis toujours a`la recherche de l'anesthe´sique local ide´al pour l'anesthe´sie rachidienne ambulatoire. La lidocaı¨ne a e´te´associe´e à une incidence e´leve´e de symptômes neurologiques temporaires, et la bupivacaı¨ne produit des blocs sensitifs et moteurs de longue dure´e. La 2-chloroprocaı¨ne (2-CP) sans agent de conservation semble eˆtre une alternative prometteuse, e´tant donne´qu'il s'agit d'un agent a`courte action qui gagne en popularite´depuis quelques anne´es. Cette e´tude a e´te´conçue afin de comparer la 2-CP a`la bupivacaı¨ne pour la rachianesthe´sie dans un contexte ambulatoire et non urgent.

SummaryPurposeTo determine the effects of omega‐3 supplementation on liver fat and carotid intima–media thickness (IMT) and to assess accuracy of ultrasound (US) for grading liver steatosis.Materials and MethodsIn this one‐way crossover pilot study, we assigned children with obesity and liver steatosis to receive 1.2 g daily of omega‐3 supplementation vs. inactive sunflower oil for 24 or 12 weeks. Liver fat content was assessed by magnetic resonance spectroscopy (MRS), magnetic resonance imaging (MRI) and US, and common carotid IMT by US. Statistical analysis included Chi‐square, Student's t‐tests, ANOVA tests and receiver operating characteristic (ROC) curves.ResultsOmega‐3 supplementation was associated with a trend towards decrease in MRS‐determined liver fat fraction (0.7% and 2.1% decrease in the 24‐week and 12‐week omega‐3 group, respectively) compared with the sunflower oil group (1.0% increase). These changes were not significant, whether assessed by MRS (P = 0.508), MRI (P = 0.508) or US (P = 0.678). Using US, the area under the ROC curves were 0.964, 0.817 and 0.783 for distinguishing inferred steatosis grades 0 vs. 1–2–3, 0–1 vs. 2–3 and 0–1–2 vs. 3, respectively, indicating good accuracy of US‐based fat grading. Omega‐3 supplementation was associated with a decrease in US‐determined IMT (0.05‐mm decrease in the 24‐week omega‐3 group. A 0.015‐mm increase was found in the 12‐week omega‐3 group, and a 0.007‐mm decrease in the sunflower oil group (P = 0.003).ConclusionOmega‐3 supplementation had no significant effect on liver fat fraction, but led to carotid IMT decrease in children with obesity and liver steatosis.