Methylene Blue Injection for Pain Reduction at Iliac Crest Donor Sites: A Randomized Trial and Meta-analysis

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Postoperative pain and gait disturbance following iliac bone grafting for alveolar clefts negatively affect patient quality of life.
• Autologous iliac bone grafting is a common procedure with associated morbidity.
• Effective pain management strategies are crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the efficacy of methylene blue in combination with ropivacaine for postoperative analgesia after iliac bone grafting.
• To evaluate the impact of methylene blue on pain scores and gait disturbance duration.
• To conduct a meta-analysis assessing methylene blue's analgesic effects across different anatomical sites.

Main Methods:

• A randomized controlled trial involving 58 patients undergoing autologous iliac bone grafting.
• Patients were randomized to receive either methylene blue-ropivacaine combination or ropivacaine alone.
• Pain scores and gait disturbance were assessed postoperatively, with results combined with 6 additional studies in a meta-analysis.

Main Results:

• The methylene blue group demonstrated significantly lower pain scores at multiple postoperative time points (12 hours, 1, 3, and 5 days).
• Duration of postoperative gait disturbance was significantly reduced in the experimental group.
• Meta-analysis confirmed methylene blue's significant pain reduction at 1 day, 3 days, 1 week, 3 months, and 6 months, but not at 1 month.

Conclusions:

• Methylene blue serves as a safe and effective adjunct for postoperative analgesia after iliac bone harvesting.
• The use of methylene blue significantly alleviates pain and shortens the duration of gait disturbance.
• No serious adverse effects were reported, supporting methylene blue's safety profile.