Objective To evaluate the efficacy of methylene blue compound for proximal intercostal nerve block during thoracotomy for radical resection of esophageal cancer, and to provide additional options for nerve block techniques in such procedures. Methods A total of 120 patients undergoing thoracotomy for radical resection of esophageal cancer from June 2022 to December 2023 were selected as study subjects and divided into a control group and an experimental group by random number table method, with 60 cases in each group. The control group received general anesthesia alone, while the experimental group received general anesthesia combined with methylene blue and ropivacaine for proximal intercostal nerve block. Operation time, blood loss during operation, the occurrence of hypotension and arrhythmia during surgery, and postoperative thoracic complications （such as pleural effusion and pulmonary infection） were recorded in the two groups. Postoperative pain was assessed using the visual analogue scale （VAS） 1, 3, 7, and 15 d after surgery. Results There were no significant differences in operation time, intraoperative blood loss, and the incidence of hypotension and arrhythmia during surgery between the two groups （P>0.05）. However, the incidence rates of postoperative thoracic complications and VAS scores in the experimental group were significantly lower than those in the control group （P<0.05）. Conclusion Methylene blue compound for proximal intercostal nerve block in thoracotomy for radical resection of esophageal cancer can effectively reduce thoracic complications and alleviate postoperative pain.