Impact of Video-Based Patient Education on Physician Trust, Pain, and Anxiety in Laparoscopic Cholecystectomy

Overview

This prospective, randomized, single-center, single-blind study aims to evaluate the effects of video-based preoperative education on physician trust, postoperative pain, anxiety, and opioid consumption in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Sixty-two ASA I-II patients aged 18-65 years will be randomized into two groups: standard verbal information alone or verbal information plus a standardized educational video regarding ultrasound-guided transversus abdominis plane (TAP) block. All patients will receive standardized general anesthesia, multimodal analgesia, and bilateral TAP block. The primary outcome will be physician trust assessed at postoperative 24 hours using the Trust in Physician Scale. Secondary outcomes include preoperative anxiety measured with the Amsterdam Preoperative Anxiety and Information Scale (APAIS), postoperative pain scores, opioid consumption, rescue analgesic requirement, and postoperative nausea and vomiting incidence. The study hypothesizes that video-based education will improve physician trust and perioperative patient-centered outcomes.

Laparoscopic cholecystectomy (LC) is associated with less postoperative pain compared with open cholecystectomy; however, postoperative pain of varying severity may still occur due to pneumoperitoneum, surgical manipulation, and patient-related factors. Multimodal analgesia strategies including systemic non-opioid analgesics, opioids, local anesthetic infiltration, and interfascial plane blocks are widely recommended for postoperative pain management after LC. Inadequate pain control may prolong hospital stay, increase morbidity, and elevate healthcare costs. Ultrasound-guided transversus abdominis plane (TAP) block has become an important component of perioperative analgesia in abdominal surgery by reducing opioid consumption and improving recovery quality. Current PROSPECT recommendations support the use of TAP block as an effective regional analgesia technique following laparoscopic cholecystectomy. Beyond pharmacological and regional analgesic techniques, patient-related psychosocial factors may significantly influence perioperative outcomes. Physician trust has been shown to affect treatment adherence, perceived quality of care, pain perception, and functional recovery. Similarly, preoperative anxiety may influence postoperative pain intensity and patient satisfaction. The Trust in Physician Scale and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) are validated instruments commonly used to assess physician trust and preoperative anxiety, respectively. Video-based preoperative education has emerged as a standardized and visually supported educational tool that may reduce anxiety, improve patient satisfaction, optimize patient expectations, and strengthen physician-patient relationships. Digital multimedia platforms are increasingly utilized in medical education, including procedural education for regional anesthesia techniques. However, there is limited evidence evaluating the impact of video-based education on patient-centered outcomes in the context of regional anesthesia. The primary objective of this study is to determine whether video-based preoperative education regarding TAP block improves physician trust compared with standard verbal information alone in patients undergoing laparoscopic cholecystectomy. Secondary objectives are to evaluate the effects of video-based education on postoperative pain scores, opioid consumption, rescue analgesic requirement, postoperative nausea and vomiting (PONV), and preoperative anxiety levels. This study is designed as a prospective, randomized, single-center, single-blind controlled trial. A total of 62 patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status I-II scheduled for elective laparoscopic cholecystectomy will be enrolled. Exclusion criteria include psychiatric disease, anticoagulant use or coagulopathy, allergy to local anesthetics, infection at the block site, thoracic deformity, and inability to comprehend pain or anxiety assessment scales. Participants will be randomized into two groups using a sealed-envelope method: Control group: standard verbal preoperative information about TAP block Video group: standard verbal information plus a standardized educational video demonstrating ultrasound anatomy and probe positioning for TAP block without showing invasive procedural steps Approximately one hour before surgery, preoperative anxiety will be evaluated using the APAIS questionnaire. All patients will undergo standardized general anesthesia and receive multimodal analgesia including dexketoprofen and tramadol before the end of surgery. Ultrasound-guided bilateral TAP block will be performed in all patients. Postoperative pain intensity will be assessed using the Numeric Rating Scale (NRS) at 0, 4, 12, and 24 hours postoperatively. Rescue analgesic requirements and total opioid consumption converted to intravenous morphine equivalents will be recorded. Physician trust will be assessed at postoperative 24 hours using the Trust in Physician Scale and will serve as the primary endpoint. Secondary endpoints include postoperative NRS pain scores, opioid consumption, preoperative anxiety scores, rescue analgesic requirement, and incidence of postoperative nausea and vomiting. Sample size calculation will be performed using G\*Power software based on pilot data, and 31 patients will be included in each group considering possible dropouts. Statistical analyses will be conducted using SPSS software. Normality of data distribution will be assessed with the Shapiro-Wilk test. Appropriate parametric or non-parametric statistical tests will be used accordingly, and a p-value \<0.05 will be considered statistically significant.