A Prospective, Randomized, Controlled Trial of Methylene Blue Injection for Costal Cartilage Harvest Postoperative Analgesia

Abstract Background In plastic surgery, costal cartilage is an excellent support material. However, postoperative pain from costal cartilage harvesting can impact patient recovery and satisfaction with the surgery. Recent reports have shown that methylene blue (MB) is an effective local analgesic in postoperative management. Objectives We aimed to evaluate the safety and effectiveness of MB for pain relief in patients undergoing costal cartilage harvesting. Methods A total of 106 patients undergoing costal cartilage harvesting surgery were selected from the plastic surgery department between December 2022 and March 2024. They were randomly divided into 2 groups: the MB group and the ropivacaine group, with 53 patients in each group. Pain levels were assessed with a numerical rating scale, the Insomnia Severity Index (ISI), arm elevation angle, and postoperative satisfaction scales at 1 day, 3 days, 5 days, 1 week, 1 month, and 3 months postoperatively. Results Patients receiving MB exhibited a significant decrease in pain scores from 5 days to 1 month of treatment compared to the ropivacaine group. Additionally, in the MB group there was an improvement in ISI scores from 5 days to 1 month compared to the ropivacaine group. Furthermore, during the 3-month follow-up, the MB group had significant increases in satisfaction scores compared to the control group. Arm elevation angle in the MB group was significantly higher compared to the ropivacaine group at 5 days, 1week, and 1month. No serious adverse events were reported, with only 2 patients experiencing an allergic rash. Conclusions Methylene blue demonstrated significant pain reduction with minimal adverse effects. Level of Evidence: 3 (Therapeutic)