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

Background: Postoperative pain and gait disturbance after iliac bone grafting for alveolar clefts significantly impact patients’ quality of life. This study investigated the effect of methylene blue on postoperative analgesia and conducted a meta-analysis of its impact on analgesia across various anatomical sites. Methods: A randomized controlled trial and meta-analysis included 58 patients undergoing autologous iliac bone grafting. Patients were randomized into 2 groups: one receiving a methylene blue–ropivacaine combination and the other receiving ropivacaine alone. Pain scores and gait disturbance duration were measured at 12 hours and at 1, 3, 5, 7, and 14 days postoperatively. A meta-analysis combined results from 6 other studies. Results: The experimental group showed significantly lower pain scores at 12 hours and at 1, 3, and 5 days. Postoperative gait disturbance duration was also significantly reduced. Meta-analysis confirmed that methylene blue significantly reduced pain at 1 day, 3 days, 1 week, 3 months, and 6 months postoperatively, but not at 1 month. Conclusions: Methylene blue is a safe and effective approach for postoperative analgesia following iliac bone harvesting, significantly reducing pain and gait disturbance duration without serious side effects.