Background: Regional anesthesia provides significant perioperative benefits, but patients often require sedation for comfort and immobility. Common sedatives such as propofol or dexmedetomidine can cause hemodynamic instability or prolonged recovery. Remimazolam, a newer ultra-short-acting benzodiazepine, has a rapid onset and offset with potentially improved safety. This systematic review aimed to assess the efficacy and safety of remimazolam for sedation during regional anesthesia.
Method: PubMed, Scopus, Web of Science, and Embase were systematically searched up to July 2025 for randomized controlled trials (RCTs) comparing remimazolam with other sedatives (propofol, dexmedetomidine) or placebo during regional anesthesia, including neuraxial techniques (spinal, epidural, combined spinal-epidural) and peripheral nerve blocks. Key outcomes included onset of sedation, depth/quality of sedation, and recovery characteristics, hemodynamic and respiratory events, postoperative nausea and vomiting (PONV), neurocognitive outcomes, and satisfaction. Data were extracted and qualitatively synthesized.
Results: Six RCTs involving 677 patients were included. Remimazolam consistently provided a rapid onset of sedation (about 4-5 min), faster than dexmedetomidine and comparable to propofol. Recovery was also shorter with remimazolam (approximately 7-11 min) compared with both comparators. It provided greater hemodynamic stability, with fewer episodes of bradycardia than dexmedetomidine and less hypotension than propofol. Respiratory safety was favorable, with no serious adverse events and lower risk in some indices compared with dexmedetomidine. The incidence of postoperative nausea and vomiting was low and similar across groups. Remimazolam was not associated with increased delirium or cognitive impairment and in some outcomes showed advantages over propofol. Patient and clinician satisfaction were consistently high.
Conclusion: Remimazolam appears to be an effective and safe sedative option for regional anesthesia, offering a rapid onset and recovery, stable hemodynamics, and minimal respiratory and neurocognitive side effects. Based on the currently limited evidence, it may represent a favorable alternative to traditional sedatives for maintaining patient comfort during regional anesthesia procedures; however, larger, high-quality trials are warranted.
Keywords: Anesthesia; Regional; Remimazolam; Safety; Sedation.
© 2026. The Author(s).