PATHOPHYSIOLOGICAL RATIONALE AND SELECTION CRITERIA FOR MULTIMODAL ANALGESIA INCORPORATING AN ERECTOR SPINAE PLANE (ESP) BLOCK IN PATIENTS WITH PURULENT-SEPTIC THORACIC DISEASES

Abstract

Objective: This study aimed to develop pathophysiologically grounded criteria for selecting multimodal analgesia with the integration of the erector spinae plane block (ESPB) in patients with purulent-septic diseases of the thoracic cavity. Methods: The study included 66 patients with mediastinitis, chronic pleural empyema, and rib osteomyelitis who received conventional opioid-centered analgesia. Pain intensity, respiratory function parameters, opioid consumption, and the incidence of postoperative pulmonary complications (PPCs) were assessed. Results: Pain at rest ≥5 points increased the risk of PPCs by 2.4 times (OR: 2.42; 95% CI: 1.17–5.00), reduced spirometry values <60% of predicted increased the risk by 2.78 times (OR: 2.78; 95% CI: 1.33–5.82), and opioid consumption ≥45 mg morphine equivalents increased the risk by 1.5 times (OR: 1.50; 95% CI: 1.00–2.26). Conclusion: Based on these findings, the "TAPS-ESPB" and "TAES" scales were developed to predict complication risk and guide analgesia management dynamically. The proposed approach enables a transition to a personalized analgesia model and contributes to a reduction in respiratory complications.