Cureus最新文献

{"title":"Improving Acute Resuscitation Plan Completion Rates Using Visual Aids in an Inpatient Setting: A Quality Improvement Study.","authors":"Michael T Byrne, Adam G Selway","doi":"10.7759/cureus.118318","DOIUrl":"10.7759/cureus.118318","url":null,"abstract":"<p><p>Background An Acute Resuscitation Plan (ARP) is a document that helps medical professionals incorporate the wishes of patients and their families, as well as the opinions of the treating team, when making decisions about treatment escalation and whether resuscitation is appropriate should a patient clinically deteriorate. This project aimed to assess if the use of visual aids increased the completion rate of ARPs in an inpatient cardiology setting. Methods We completed a two-cycle quality improvement study using the plan-do-study-act framework, starting with an initial audit before introducing interventions in the form of visual aids over three weeks. Re-auditing occurred each week to assess the impact of the interventions on inpatient ARP completion. Results The baseline audit, conducted prior to any interventions, showed an ARP completion rate of 16% across all patients admitted under cardiology. After the first cycle of the project involving the introduction of posters and a change to the cardiology doctor's ward list, the ARP completion rate increased to 47.6% (p = 0.027). After a second cycle, introducing further visual aids attached to mobile workstations, the ARP completion rate rose to 52.2% (p = 0.014), showing a significant rise compared to baseline. Conclusions This project demonstrated that the use of visual aids significantly increased the rate of ARP completion in an inpatient cardiology setting. To further assess the success of these interventions, we suggest expanding this project hospital-wide and monitoring the ARP completion rate over a prolonged period to demonstrate the effectiveness of these interventions in the longer term.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118318"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13708941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Mix and Protocol Constraints in Diagnostic Language Model Conversations: A Secondary Analysis of Released MedR-Bench Outputs.","authors":"Oscar Mingtian Li, Summer Xia Tian Li, Yijiang Li","doi":"10.7759/cureus.118344","DOIUrl":"https://doi.org/10.7759/cureus.118344","url":null,"abstract":"<p><p>Introduction Diagnostic language models can request additional examinations before answering. Their observed stopping behavior depends on the model, the information returned by a simulator, and the interaction protocol, and these contributions are difficult to separate in aggregate benchmark results. We quantified an explicit unavailable-information text marker in simulator feedback and its association with fifth-response contact, a protocol-imposed interaction limit. Methods We analyzed released MedR-Bench diagnosis conversations from seven model labels and 957 source case reports. Exposure was a text marker: the exact simulator sentence stating that no relevant ancillary test information was available, in the first simulator feedback. It was not a clinical judgment that information was missing. The outcome was fifth-response contact, meaning that the run reached the fifth assistant response. Within-model risk differences were averaged with equal model weights, with 5,000 report-cluster bootstrap resamples. Sensitivity analyses used linear probability models with model effects and then report and model effects, with and without first-request composition, and leave-one-model-out summaries. Results Of 6,699 expected report-model cells, 6,690 were released, and 5,719 entered the first-feedback analysis; entry ranged from 41.2% to 98.0% of released runs by model. The marker appeared in 4,593 first feedbacks (80.3%), and 96.2% of these also returned other text for at least one requested item. All 1,001 fifth-response runs followed a mandatory-final-answer prompt. The equal-model-weighted difference was 6.37 percentage points (95% CI 4.16 to 8.54), or 4.16 points without the model with the largest difference. The difference largely reflected case composition: the common-slope coefficient was 5.61 points with model effects, 1.05 points (95% CI -1.64 to 3.74) with report and model effects, and 1.21 points (-1.67 to 4.08) after adding request composition. In paired one-round and free-turn releases, marker status differed in 1,309 of 5,701 pairs (23.0%) despite identical case text. Conclusions The positive association between the unavailable-information text marker and fifth-response contact was largely explained by case composition and was close to null within source reports. Case composition and protocol states should remain visible when diagnostic trajectories are evaluated. These data do not establish a causal effect of missing information or support heart-failure clinical validation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118344"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Hypoplasia of the C1 Posterior Arch Masquerading as Multiple Sclerosis: A Case Report.","authors":"Youssef A Abdelmegeid, Ikinu Wambugu, Mohamed M Hegazy, Mahmoud AlHadidi","doi":"10.7759/cureus.118319","DOIUrl":"https://doi.org/10.7759/cureus.118319","url":null,"abstract":"<p><p>Hypoplasia of the C1 posterior arch is a rare congenital anomaly, classified using the Currarino system into subtypes A through E depending on the extent and nature of arch deficiency. The majority of cases are incidental radiological findings; symptomatic presentations causing cervical myelopathy are exceptionally uncommon and not well represented in the surgical literature. In such cases, the absence of established management guidelines renders clinical decision-making particularly challenging. We present a case of a 45-year-old male surgeon who presented with a one-year history of episodic bilateral upper and lower limb weakness. Initial investigations, including brain and cervical spine MRI, were interpreted as consistent with a diagnosis of multiple sclerosis, for which treatment was commenced. Following a symptom-free interval after a one-month course of corticosteroids, the patient experienced a recurrence at eight months, prompting dynamic MRI of the cervical spine, which revealed a type C hypoplastic C1 posterior arch causing dynamic spinal cord compression during hyperextension. The diagnosis was revised accordingly. Supplementary investigations confirmed atlantoaxial stability and normal vertebral artery anatomy bilaterally. The patient provided consent and underwent posterior surgical decompression of the entire posterior arch, without instrumented fusion. Intraoperative neurophysiological monitoring guided the extent of resection; decompression began on the fibrous left-sided arch, extending to the level of the vertebral artery groove, followed by the bony right-sided arch, sequenced to preserve facet joint integrity. The patient achieved complete symptom resolution postoperatively. This case highlights the diagnostic challenge posed by symptomatic C1 arch hypoplasia, which may mimic demyelinating disease, and demonstrates that surgical decompression, guided by intraoperative neurophysiological monitoring and tailored to arch morphology, can achieve excellent neurological outcomes without the need for instrumented stabilisation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118319"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin B6 Doses on United States Dietary Supplement Labels Relative to the Tolerable Upper Intake Level: A Census of the National Institutes of Health Dietary Supplement Label Database.","authors":"Brian Staiger","doi":"10.7759/cureus.118244","DOIUrl":"https://doi.org/10.7759/cureus.118244","url":null,"abstract":"<p><p>Background High intakes of vitamin B6 can cause peripheral neuropathy. The United States (US) tolerable upper intake level (UL) for adults is 100 mg/day, and several other jurisdictions now apply far lower limits. No study has measured where US supplement labels sit against the US UL. Methodology This census retrieved every label flagged on the market in the National Institutes of Health Dietary Supplement Label Database (DSLD) on October 4, 2026 (plus eight labels found by an additional search spelling on October 13, 2026) that listed vitamin B6 under any spelling, merged the separate records that DSLD keeps when one product has a different package size, label image or alternate version into a single product, computed the maximum daily dose from each label's own directions, and compared it with the UL for adults or for the stated age band and with the lower thresholds of 12 and 50 mg/day used elsewhere. Every product at or above a US limit was verified against its raw record. Proportions carry Wilson 95% confidence intervals (CIs). Results Of 16951 labels, 15091 stated a vitamin B6 amount, forming 11913 products (11367 adult). The median maximum directed dose of adult products was 10 mg/day (interquartile range 2.2 to 25 mg/day). Overall, 575 of 11367 adult products (5.1%; 95% CI 4.7% to 5.5%) directed 100 mg/day or more, 167 (1.5%) more than 100 mg/day, and 10 at least 500 mg/day, with the highest being 1000 mg/day as the compound weight of a pyridoxine salt. Of these 575, 323 (56.2%) were not sold as vitamin B6 or B-complex products. In addition, 4399 adult products (38.7%) exceeded 12 mg/day and 1034 (9.1%) exceeded 50 mg/day. Label directions on 22 products gave a stated child or teen age a dose above the UL for that age, up to 250 mg/day for ages 4 and older (UL 40 mg/day). Verification excluded 12 inconsistent DSLD records and corrected 21 mis-encoded serving records. Conclusions One in 20 adult vitamin B6 supplements on the US market directs at least the UL daily, mostly in products not sold as vitamin B6, and single tablets reach five times the limit; nearly two in five exceed the European limit of 12 mg/day. The findings support a neuropathy warning on high-dose labels, a reassessment of the 1998 UL, and attention to vitamin B6 content when neuropathy is evaluated.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118244"},"PeriodicalIF":1.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Myxoma in a Patient With Missed Abortion: A Diagnostic Dilemma.","authors":"Reenu Kanwar, Shubham Bidhuri, Madhumita Patel, Manjula Sharma","doi":"10.7759/cureus.118225","DOIUrl":"https://doi.org/10.7759/cureus.118225","url":null,"abstract":"<p><p>Ovarian myxoma is a rare benign mesenchymal tumor. It can be completely asymptomatic and is difficult to differentiate from other ovarian masses before surgery and final histopathology. We report a case of a 28-year-old primigravida who presented with a missed abortion at 11 weeks. Transvaginal ultrasonography incidentally showed a 6.5 × 5.7 cm complex solid-cystic right adnexal lesion in the pouch of Douglas. She was asymptomatic from the mass. After dilatation and evacuation for missed abortion, the patient was evaluated for an ovarian mass, and tumor markers were found negative. Repeat ultrasonography showed a heterogeneous lesion with coarse hyperechoic foci and posterior acoustic shadowing, suggesting a right ovarian teratoma. The patient was taken for laparotomy, wherein an 8 × 8 cm solid-cystic mass was found in the right ovary, and right ovarian cystectomy was done. Intraoperative scrape cytology came back negative for malignancy and showed columnar cells, squamous cells, and mature adipose tissue, which favored a benign cystic teratoma. Histopathology showed a thick collagenous capsule and stellate cells in abundant myxoid stroma without atypia. On immunohistochemistry, the tumor cells were positive for vimentin and negative for desmin and cytokeratin. The final diagnosis was ovarian myxoma. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. There was no recurrence at one-year follow-up. This case shows that ovarian myxoma can mimic a mature cystic teratoma on imaging, gross examination, and cytology, and that the final diagnosis depends on histopathological examination (HPE) supported by immunohistochemistry.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118225"},"PeriodicalIF":1.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Monitoring in Recurrent Venous Thromboembolism Associated With Antiphospholipid Antibodies and Subsequent Heparin-Induced Thrombocytopenia.","authors":"George Bechir","doi":"10.7759/cureus.118258","DOIUrl":"https://doi.org/10.7759/cureus.118258","url":null,"abstract":"<p><p>A woman in her 20s with class III obesity and strongly positive antiphospholipid antibodies developed phlegmasia cerulea dolens and a new pulmonary embolus after recent catheter-directed thrombolysis. Before the first documented heparin administration, activated partial thromboplastin time was 95.5 s and international normalized ratio was 1.5. Eight subsequent paired samples showed activated partial thromboplastin times of 176 s to over 200 s with heparin anti-Xa activity of 0.20-0.66 IU/mL. Lupus anticoagulant testing was uninterpretable during anticoagulation, and international normalized ratio reliability was not independently established. Later thrombocytopenia prompted repeat heparin-induced thrombocytopenia testing despite an earlier negative result; a strongly positive immunoassay supported the treating team's diagnosis and transition to fondaparinux. This case illustrates the importance of selecting appropriate anticoagulation monitoring from the outset and reassessing heparin-induced thrombocytopenia when the clinical picture changes. Whether assay interference contributed to recurrent thrombosis remains unresolved.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118258"},"PeriodicalIF":1.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse-Type Tenosynovial Giant Cell Tumor of the Flexor Hallucis Longus Tendon Sheath: A Case Report.","authors":"Anas Chbabou, Ayoub Mokhtari, Thomas Saliba","doi":"10.7759/cureus.118245","DOIUrl":"https://doi.org/10.7759/cureus.118245","url":null,"abstract":"<p><p>The synovium can be the primary site for the development of various benign or malignant tumors. Tenosynovial giant cell tumor (TGCT), also known as giant cell tumor of the tendon sheath, is a benign but locally aggressive synovial neoplasm occurring in localized and diffuse forms. The localized form predominantly affects the hand, whereas the diffuse form mainly involves large joints; involvement of the flexor hallucis longus tendon sheath is rare. Magnetic resonance imaging (MRI) is the principal modality for demonstrating the hemosiderin deposits characteristic of this lesion, although histopathology remains necessary for definitive diagnosis. Surgical resection remains the standard treatment. We report the case of a 24-year-old man with 10 months of right ankle pain, related to a diffuse-type TGCT involving the flexor hallucis longus tendon sheath and adjacent ankle joints. Radiographs initially showed soft-tissue filling of Kager's triangle. Computed tomography arthrography demonstrated synovial thickening but was nonspecific; MRI then revealed the characteristic findings, and histopathology confirmed the diagnosis. This report aims to raise awareness of this rare location and its associated diagnostic pitfalls.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118245"},"PeriodicalIF":1.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Out of Hours: A Narrative Review of Balancing Responsibility, Supervision, and Fatigue in Junior Doctor Training.","authors":"Rosamma Lenitte Thomas","doi":"10.7759/cureus.118217","DOIUrl":"https://doi.org/10.7759/cureus.118217","url":null,"abstract":"<p><p>Out-of-hours work is an integral component of postgraduate medical training and exposes junior doctors to clinical responsibility, uncertainty, competing demands, and acute deterioration in circumstances that may differ substantially from routine daytime practice. These conditions can provide valuable opportunities for experiential learning, but they can also reduce educational value when responsibility is accompanied by inadequate supervision, excessive workload or fatigue. This narrative review examines out-of-hours work as a learning environment for junior doctors, integrating literature on workplace learning, autonomy and supervision, prioritisation and decision-making, deterioration and escalation, handover and teamwork, sleep disruption and fatigue, and educational interventions designed to prepare trainees for out-of-hours practice. The literature suggests that the educational value of out-of-hours work arises not from independence alone, but from meaningful clinical responsibility within an appropriately supported environment. Responsibility can provide opportunities for autonomous initial assessment, prioritisation, and decision-making under uncertainty, while the recognition of personal limits and appropriate escalation are themselves components of developing clinical judgement. Simulation and structured preparation may help trainees rehearse these demands before substantial clinical responsibility is assumed, while feedback, reflection, and review of subsequent patient outcomes can help convert clinical exposure into learning. However, excessive workload, inadequate supervision, and fatigue may impair both the opportunity and the capacity to learn. Out-of-hours training should therefore aim to preserve authentic responsibility while ensuring that autonomy is graded to capability, senior support remains accessible, workload is manageable, and opportunities for feedback and recovery are maintained. We propose that effective out-of-hours learning occurs within a zone of meaningful responsibility in which trainees are sufficiently challenged to develop clinical judgement without becoming unsupported or physiologically unsustainable. Designing this environment requires attention not only to individual preparedness but also to supervision, staffing, workload, handover, feedback, and rota design.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118217"},"PeriodicalIF":1.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Response to Upadacitinib in Treatment-Experienced Patients With Atopic Dermatitis: A Case Series From Latin America.","authors":"Ana B Crocker Sandoval, Yocelin N Lozano Figueroa, Ana G Perez-Romero, Alan O Muro-Davalos","doi":"10.7759/cureus.118166","DOIUrl":"10.7759/cureus.118166","url":null,"abstract":"<p><p>Atopic dermatitis (AD) is a chronic inflammatory skin disease that may require systemic therapy in patients with persistent disease activity or an inadequate response to previous treatments. Upadacitinib, a selective Janus kinase 1 inhibitor, has demonstrated rapid clinical efficacy in patients with moderate-to-severe AD; however, real-world data from Latin American populations remain limited. We describe the clinical responses and treatment outcomes of five adult patients with AD from Mexico who received oral upadacitinib after previous treatment with topical and/or systemic therapies. Clinical response was assessed using the Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS) for pruritus, and Dermatology Life Quality Index (DLQI) at baseline and week 2, with subsequent follow-up ranging from six months to two years. Four patients initiated upadacitinib 15 mg once daily, whereas one initially received 30 mg once daily and was subsequently reduced to 15 mg because of elevated liver enzyme levels. At week 2, all five patients experienced clinical improvement, with EASI reductions ranging from 40% to 54.5%, NRS reductions of 50-80%, and DLQI scores decreasing to 1-3. All patients maintained clinical improvement during follow-up and ultimately achieved an EASI score ≤3 and a DLQI score of 0. Notably, two patients who had previously experienced disease relapse during dupilumab treatment demonstrated marked improvement after switching to upadacitinib. One patient developed elevated liver enzyme levels approximately 1.5 times the upper limit of normal, which resolved after dose reduction; no other adverse events were reported. These cases highlight the potential role of upadacitinib in treatment-experienced patients with AD, including those with disease relapse following dupilumab treatment. Larger prospective studies are needed to further evaluate its effectiveness and safety in Latin American populations.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118166"},"PeriodicalIF":1.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Laparoscopic-Assisted Transversus Abdominis Plane Block and Trocar-Site Local Anesthetic Infiltration After Laparoscopic Appendectomy: A Randomized Controlled Trial.","authors":"İksan Taşdelen, Fatih Kilic, Kemal Memişoğlu, Ahmet Yalin Iscan, Bülent Kaya, Arzu Yildirim Ar","doi":"10.7759/cureus.118156","DOIUrl":"10.7759/cureus.118156","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Abdominal wall blocks are increasingly used for pain control following laparoscopic appendectomy. This study aimed to compare the analgesic efficacy of a transversus abdominis plane (TAP) block performed by the surgical team under direct laparoscopic visualization with trocar-site infiltration using an equal total dose of local anesthetic (LA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Sixty patients who underwent laparoscopic appendectomy for uncomplicated acute appendicitis between August 2017 and January 2018 were prospectively randomized in a 1:1 ratio into two groups. In the TAP group (n = 30), 15 mL of 0.25% bupivacaine was administered bilaterally under direct laparoscopic visualization before appendectomy. In the LA group (n = 30), 5 mL of 0.5% bupivacaine was infiltrated at each trocar site before incision. The total bupivacaine dose was standardized to 75 mg in both groups. Pain intensity was measured using the visual analog scale (VAS) at postoperative hours 0, 2, 6, 12, and 24. The two groups were compared in terms of rescue analgesic consumption; time to first mobilization, first passage of flatus, and initiation of oral intake; nausea and vomiting; complications; and length of hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The groups were comparable in terms of age, sex, body mass index, and American Society of Anesthesiologists (ASA) score (all p &gt; 0.05). VAS scores were significantly lower in the TAP group at all measured time points (hour 0, p = 0.005; hour 2, p = 0.022; hour 6, p = 0.020; hour 12, p = 0.020; and hour 24, p = 0.001; effect sizes, r = 0.34-0.49). In the TAP group, 19 of 30 patients (63.3%) required no rescue analgesia during the first 24 hours, compared with 11 of 30 (36.7%) in the LA group (p = 0.039); the total number of nonsteroidal anti-inflammatory drug (NSAID) doses per patient was significantly lower in the TAP group (p = 0.023). Although opioid requirements were numerically lower in the TAP group, the difference did not reach statistical significance (2/30, 6.7% vs. 7/30, 23.3%; p = 0.071). Oral intake was initiated earlier in the TAP group (median, 8.0 vs. 10.0 hours; p = 0.018). The median length of hospital stay was 24.0 hours in the TAP group and 32.0 hours in the LA group (p = 0.002), and the proportions of patients discharged within 24 hours were 16 of 30 (53.3%) and 3 of 30 (10.0%), respectively (p &lt; 0.001). No differences were observed between the groups in mobilization, passage of flatus, or the frequency of nausea and vomiting. No complications related to block administration were observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A surgeon-performed TAP block under laparoscopic visualization provides lower pain scores and reduces analgesic consumption during the first 24 hours following laparoscopic appendectomy compared with trocar-site infiltration using an equal dose of LA. As it requires neither additional equipment nor ultrasonographic expertise,","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118156"},"PeriodicalIF":1.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}