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Effect of methylene blue on experimental postoperative adhesion: A systematic review and meta-analysis
Su Hyun Seo1, Geun Joo Choi1, Oh Haeng Lee1
1Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Abstract:
Adhesion is a primary challenge following surgery, and the anti-adhesive effect of methylene blue (MB) has been investigated. This systematic review and meta-analysis aimed to evaluate the effect of MB on postoperative adhesions in experimental studies. We initially searched OVID-MEDLINE, EMBASE, and Google Scholar in February 2021, and then in May 2021. The anti-adhesive efficacy of MB was compared with that of the control (either placebo or nothing) after the surgical procedure. The primary and secondary outcomes were the macroscopic and microscopic adhesion scores, respectively. Traditional meta-analysis, meta-regression, and trial sequential analysis (TSA) were performed to analyze the retrieved outcomes. We included 13 experimental studies of 367 rats (200 rats received MB and 167 rats received placebo or nothing). The macroscopic adhesion scores were significantly lower in the MB-administered group than in the control group (standardized mean difference, 2.313; 95% confidence interval, 1.104 to3.523; I2 = 94.0%, Tau = 2.059). Meta-regression analysis showed that macroscopic adhesion tended to decrease with an increase in MB dose. TSA demonstrated that the cumulative Z curve crossed both the conventional test and trial sequential monitoring boundary for the macroscopic adhesion score. MB had a beneficial effect on intraperitoneal adhesion following laparotomy, and adhesions decreased with increase in dose.
Insights
Methylene blue (MB) significantly reduces postoperative adhesions in experimental studies. Higher MB doses correlate with greater reductions in adhesion scores, indicating a beneficial anti-adhesive effect.
Area of Science:
- Surgical Research
- Pharmacology
- Biomedical Engineering
Background:
- Postoperative adhesions are a significant surgical complication.
- Methylene blue (MB) has demonstrated potential anti-adhesive properties.
Purpose of the Study:
- To systematically review and meta-analyze the anti-adhesive effect of MB in experimental studies.
- To evaluate MB's efficacy in reducing postoperative adhesions.
Main Methods:
- Systematic review and meta-analysis of 13 experimental studies involving 367 rats.
- Comparison of MB administration versus control (placebo or nothing).
- Analysis of macroscopic and microscopic adhesion scores using traditional meta-analysis, meta-regression, and trial sequential analysis (TSA).
Main Results:
- MB administration resulted in significantly lower macroscopic adhesion scores compared to controls (SMD 2.313).
- Meta-regression indicated a dose-dependent decrease in macroscopic adhesion with increasing MB dosage.
- TSA confirmed the reliability of the findings for macroscopic adhesion scores.
Conclusions:
- Methylene blue exhibits a beneficial effect in preventing intraperitoneal adhesions after laparotomy.
- The anti-adhesive efficacy of MB is dose-dependent, with higher doses yielding better results.
