Comparative Efficacy of Remimazolam Versus Propofol in Meningioma Surgery with Scalp Nerve Block.

BACKGROUND This study aimed to evaluate the advantages of remimazolam combined with selective scalp nerve block in patients undergoing craniotomy for meningioma. MATERIAL AND METHODS A total of 300 patients undergoing craniotomy for meningioma were enrolled and randomly assigned to either the control group (n=150, propofol + selective scalp nerve block) or the experimental group (n=150, remimazolam + selective scalp nerve block). Hemodynamic parameters, pain intensity, central nervous system-specific protein levels (S100-beta protein [S100-b]), inflammatory markers, and the incidence of adverse reactions were recorded and compared at multiple postoperative time points. RESULTS Visual analog scale scores, S100-ß levels, and levels of inflammatory factors - interleukin-6, tumor necrosis factor-alpha, and C-reactive protein - were significantly lower in the experimental group than in the control group at 2, 8, 12, and 24 h postoperatively (all P<0.05). The incidence of adverse reactions was significantly lower in the experimental group (2.67%) than in the control group (13.33%) (P<0.05). Although systolic blood pressure, diastolic blood pressure, and heart rate decreased after anesthesia induction in both groups, the experimental group exhibited more stable hemodynamic profiles (all P<0.05). CONCLUSIONS Remimazolam combined with selective scalp nerve block enhances analgesia, reduces brain injury and inflammatory markers, lowers the incidence of adverse effects, and provides more stable intraoperative hemodynamics in patients undergoing craniotomy for meningioma.