Scholars@Duke
Stephen Matthew Klein

Stephen Matthew Klein

Professor of Anesthesiology
Anesthesiology, Ambulatory
klein006@mc.duke.edu
Box 3094 Med Ctr, Durham, NC 27710
2508 North Pavilion, Durham, NC 27705

Selected Publications

Effect of Interscalene Brachial Plexus Block on the Pulmonary Function of Obese Patients: A Prospective, Observational Cohort Study.

Journal Article Anesth Analg · July 2017 BACKGROUND: The effect of interscalene block (ISB) on pulmonary function of obese participants has not been investigated. The goal of this study is to assess the association of obesity (body mass index [BMI] >29 kg/m vs BMI <25 kg/m) and change in forced v ... Full text Link to item Cite

Changes in Brain Resting-state Functional Connectivity Associated with Peripheral Nerve Block: A Pilot Study.

Journal Article Anesthesiology · August 2016 BACKGROUND: Limited information exists on the effects of temporary functional deafferentation (TFD) on brain activity after peripheral nerve block (PNB) in healthy humans. Increasingly, resting-state functional connectivity (RSFC) is being used to study br ... Full text Open Access Link to item Cite

Long-acting serotonin antagonist (Palonosetron) and the NK-1 receptor antagonists: does extended duration of action improve efficacy?

Journal Article Anesthesiol Clin · June 2014 In a growing outpatient surgical population, postdischarge nausea and vomiting (PDNV) is unfortunately a common and costly anesthetic complication. Identification of risk factors for both postoperative nausea and vomiting and PDNV is the hallmark of preven ... Full text Link to item Cite

New medications and techniques in ambulatory anesthesia.

Journal Article Anesthesiol Clin · June 2014 Novel anesthetic and analgesic agents are currently under development or investigation to improve anesthetic delivery and patient care. The pharmacokinetic and analgesic profiles of these agents are especially tailored to meet the challenges of rapid recov ... Full text Link to item Cite

Peripheral nerve stimulation in regional anesthesia.

Journal Article Reg Anesth Pain Med · 2012 Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. I ... Full text Link to item Cite

Management of postdischarge nausea and vomiting after ambulatory surgery.

Journal Article Curr Opin Anaesthesiol · December 2011 PURPOSE OF REVIEW: Although there are extensive studies of postoperative and postdischarge nausea and vomiting (PONV/PDNV) up to 24  h, few investigate 'delayed PDNV'. With an increasing outpatient surgical population, specific 'delayed PDNV' risk identifi ... Full text Link to item Cite

Chronic tears of the reflected head of the rectus femoris: results of operative treatment.

Journal Article Am J Sports Med · September 2011 BACKGROUND: While the majority of quadriceps muscle strains can be managed nonoperatively, rare cases remain symptomatic despite nonoperative treatment. PURPOSE: The purpose of this study is to report on results of surgical treatment of a limited number of ... Full text Link to item Cite

In response

Journal Article Anesthesia and Analgesia · December 1, 2010 Full text Cite

Miscoding rates for professional anesthesia billing: Trial results - software solution

Journal Article Electronic Journal of Health Informatics · December 1, 2010 Background: Accurate anesthesia billing requires selection of Anesthesia Current Procedural Terminology (Anesthesia CPT-4) codes that are in concordance with the American Medical Association CPT-4 (AMA CPT-4) codes selected by the surgeon. We present a stu ... Cite

Contralateral local anesthetic spread from an outpatient interscalene catheter.

Journal Article Can J Anaesth · October 2010 PURPOSE: Ambulatory continuous infusions have been associated with improved analgesia and few serious complications. This report describes an unusual case of a patient with a continuous interscalene nerve block who developed a contralateral upper extremity ... Full text Link to item Cite

Processed electroencephalogram during donation after cardiac death.

Journal Article Anesth Analg · May 1, 2010 We present a case series of increased bispectral index values during donation after cardiac death (DCD). During the DCD process, a patient was monitored with processed electroencephalogram (EEG), which showed considerable changes traditionally associated w ... Full text Link to item Cite

Double-blind comparison of granisetron, promethazine, or a combination of both for the prevention of postoperative nausea and vomiting in females undergoing outpatient laparoscopies.

Journal Article Can J Anaesth · November 2009 PURPOSE: Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are common problems after surgery. Prophylactic combination antiemetic therapy is recommended for patients at high risk for developing PONV and PDNV. Granisetron ... Full text Link to item Cite

Computer-based finite element modeling of insulated Tuohy needles used in regional anesthesia.

Journal Article Anesthesiology · June 2009 BACKGROUND: Differences in needle design may impact nerve localization. This study evaluates the electrical properties of two insulated Tuohy needles using computational finite element modeling. METHODS: Three-dimensional geometric computer-based models we ... Full text Link to item Cite

Regional anesthesia for acute pain management in the outpatient setting

Chapter · January 1, 2009 Ambulatory surgery includes procedures following which, the patients are discharged from a health care facility within 23 hours. Advances in minimally invasive surgical technique have contributed to the frequency of outpatient procedures. Institutional fis ... Full text Cite

Piezoelectric vibrating needle and catheter for enhancing ultrasound-guided peripheral nerve blocks.

Journal Article Anesth Analg · December 2007 Ultrasound imaging has been used for performing single-injection peripheral nerve blocks and continuous catheters. One limitation with current technology is the inability to confirm the location of the needle or catheter tip. We describe a new needle and c ... Full text Link to item Cite

Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications.

Journal Article Indian J Orthop · July 2007 BACKGROUND: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using ... Full text Link to item Cite

A computer model of electrical stimulation of peripheral nerves in regional anesthesia.

Journal Article Anesthesiology · February 2007 BACKGROUND: Nerve stimulation for regional anesthesia can be modeled mathematically. The authors present a mathematical framework to model the underlying electrophysiology, the development of software to implement that framework, and examples of simulation ... Full text Link to item Cite

Pudendal nerve stimulation evokes reflex bladder contractions in persons with chronic spinal cord injury.

Journal Article Neurourol Urodyn · 2007 AIMS: Although electrical stimulation of the pudendal nerve has been shown to evoke reflex micturition-like bladder contractions in both intact and spinalized cats, there is little evidence to suggest that an analogous excitatory reflex exists in humans, p ... Full text Link to item Cite

The effect of age on sciatic nerve block duration.

Journal Article Anesth Analg · February 2006 The physiologic changes that occur with advancing age and their effect on the duration of peripheral nerve blocks have yet to be defined. We prospectively studied the duration of sciatic nerve block using mepivacaine in younger and older patients. Eighty A ... Full text Link to item Cite

Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations.

Journal Article Reg Anesth Pain Med · 2006 BACKGROUND AND OBJECTIVES: Lumbar-plexus and sciatic-nerve blocks are commonly combined for lower-extremity anesthesia using large doses of ropivacaine. Limited information is available about the pharmacokinetics of this practice. We analyzed plasma ropiva ... Full text Link to item Cite

Peripheral nerve block techniques for ambulatory surgery.

Journal Article Anesth Analg · December 2005 Peripheral nerve blocks (PNBs) have an increasingly important role in ambulatory anesthesia and have many characteristics of the ideal outpatient anesthetic: surgical anesthesia, prolonged postoperative analgesia, and facilitated discharge. Critically eval ... Full text Link to item Cite

Continuous peripheral nerve blocks: fewer excuses.

Journal Article Anesthesiology · November 2005 Full text Link to item Cite

A lesson learned.

Journal Article Anesthesiology · August 2005 Full text Link to item Cite

Peripheral nerve blocks and continuous catheter techniques.

Journal Article Anesthesiol Clin North Am · March 2005 Peripheral nerve blocks provide intense, site-specific analgesia and are associated with a lower incidence of side effects when compared with many other modalities of postoperative analgesia. Continuous catheter techniques further prolong these benefits. T ... Full text Link to item Cite

Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks.

Journal Article Anesthesiology · January 2005 BACKGROUND: Regional anesthesia is increasing in popularity for ambulatory surgical procedures. Concomitantly, the prevalence of obesity in the United States population is increasing. The objective of the present investigation was to assess the impact of b ... Full text Link to item Cite

Continuous peripheral nerve block for battlefield anesthesia and evacuation.

Journal Article Reg Anesth Pain Med · 2005 Peripheral nerve and continuous peripheral nerve block (CPNB) have the potential to be valuable techniques in combat anesthesia. We describe the first successful application of CPNB in the pain management and surgical management of a combat casualty as he ... Full text Link to item Cite

A lesson learned.

Journal Article Can J Anaesth · 2005 Full text Link to item Cite

Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery - an analysis of 9,342 blocks.

Journal Article Can J Anaesth · October 2004 PURPOSE: Regional anesthesia can be the technique of choice for selected ambulatory surgery procedures, but in spite of its benefits, it has an inherent failure rate even in experienced hands. We examine the efficacy and factors associated with failure of ... Full text Link to item Cite

Techniques in Regional Anesthesia and Pain Management: Introduction

Journal Article Techniques in Regional Anesthesia and Pain Management · April 1, 2004 Full text Cite

In situ images of the thoracic paravertebral space.

Journal Article Reg Anesth Pain Med · 2004 BACKGROUND AND OBJECTIVES: In situ knowledge about the anatomic structures and the path of a needle percutaneously placed into the paravertebral space is an area that continues to be investigated. We describe an endoscopic technique that permits imaging of ... Full text Link to item Cite

Ambulatory continuous interscalene brachial plexus blockade

Journal Article Techniques in Regional Anesthesia and Pain Management · January 1, 2004 Full text Cite

Successful resuscitation after ropivacaine-induced ventricular fibrillation.

Journal Article Anesth Analg · September 2003 Human data about resuscitation after cardiac arrest from ropivacaine are limited. We present a case of successful cardiopulmonary resuscitation after accidental ropivacaine-induced ventricular fibrillation. A 76-yr-old female patient presented for foot ost ... Full text Link to item Cite

Continuous paravertebral catheter and outpatient infusion for breast surgery.

Journal Article Anesth Analg · September 2003 Paravertebral somatic nerve block (PVB) provides improved analgesia and decreased side effects compared with general anesthesia for breast surgery. The analgesia is limited with single injection PVB to the duration of the local anesthetic. Continuous parav ... Full text Link to item Cite

Brachial plexus blocks: infusions and other mechanisms to provide prolonged analgesia.

Journal Article Curr Opin Anaesthesiol · August 2003 PURPOSE OF REVIEW: Regional anesthesia has numerous benefits for upper extremity surgery such as improved analgesia, opioid sparing and reduced side effects. However, many of these advantages are lost after block regression. Recently, several strategies su ... Full text Link to item Cite

Loop ileostomy closure at an ambulatory surgery facility: a safe and cost-effective alternative to routine hospitalization.

Journal Article Dis Colon Rectum · April 2003 INTRODUCTION: Temporary loop ileostomies have become widely used in colorectal surgery. Subsequent ileostomy closure has traditionally required hospital admission with observation until return of bowel function. On the basis of clinical observation, the au ... Full text Link to item Cite

Paravertebral block anesthesia for inguinal hernia repair.

Journal Article World J Surg · April 2003 Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complicati ... Full text Link to item Cite

The difficulties of ambulatory interscalene and intra-articular infusions for rotator cuff surgery: a preliminary report.

Journal Article Can J Anaesth · March 2003 PURPOSE: Rotator cuff repair may result in severe postoperative pain. We compared a continuous intra-articular infusion to a continuous interscalene block with ropivacaine for patients undergoing outpatient rotator cuff repair. METHODS: Seventeen patients ... Full text Link to item Cite

Altered perceptions after upper and lower extremity blocks: an initial investigation.

Journal Article Reg Anesth Pain Med · 2003 BACKGROUND AND OBJECTIVES: Nerve blocks frequently produce unusual altered perceptions in the extremities. We examined perceptual changes experienced after peripheral blocks. METHODS: Fifty consecutive patients having an upper or lower extremity block for ... Full text Link to item Cite

Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases.

Journal Article Can J Anaesth · January 2003 PURPOSE: Continuous interscalene brachial plexus blockade (CIBPB) in a hospital setting can provide excellent surgical conditions and postoperative analgesia for major shoulder surgery. This is a case report of four patients on the efficacy and advantages ... Full text Link to item Cite

Femoral nerve blocks

Journal Article Techniques in Regional Anesthesia and Pain Management · January 1, 2003 Peripheral nerve blocks can provide high-quality anesthesia and analgesia after unilateral lower-extremity surgery. Lower-extremity nerve blocks, though underused, have significant advantages to central neuraxial techniques, especially in the ambulatory se ... Full text Cite

Ambulatory surgery with long acting regional anesthesia.

Journal Article Minerva Anestesiol · November 2002 Ambulatory surgery has grown dramatically in the past 3 decades; however, advances in postoperative pain treatment have not kept pace with the proliferation of outpatient procedures. Two techniques that may offer a solution to part of this problem are long ... Link to item Cite

Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting.

Journal Article Anesth Analg · November 2002 UNLABELLED: Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). We designed this study to prospectively compare the efficacy of ropivacaine as an alternative to li ... Full text Link to item Cite

Bilateral continuous paravertebral catheters for reduction mammoplasty.

Journal Article Acta Anaesthesiol Scand · September 2002 Surgical procedures of the breast can result in significant postoperative pain. Paravertebral nerve blocks have been used successfully in the management of analgesia after breast surgery but are limited by a single injection. This report describes the use ... Full text Link to item Cite

Intraarticular analgesia in shoulder surgery.

Journal Article Anesth Analg · August 2002 Link to item Cite

Preface

Journal Article Best Practice and Research: Clinical Anaesthesiology · June 1, 2002 Full text Cite

Peripheral nerve blockade with long-acting local anesthetics: a survey of the Society for Ambulatory Anesthesia.

Journal Article Anesth Analg · January 2002 UNLABELLED: Despite the growth of ambulatory anesthesia and the renewed popularity of regional techniques, there is little current information concerning outpatient regional anesthesia practices or attitudes about discharge with an insensate extremity. We ... Full text Link to item Cite

Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy.

Journal Article Reg Anesth Pain Med · 2002 BACKGROUND: Inguinal herniorrhaphy (IH) is a common outpatient procedure, yet postoperative pain and anesthetic side effects remain a problem. Paravertebral somatic nerve blocks (PVB) have the potential to offer unilateral abdominal wall anesthesia and lon ... Full text Link to item Cite

Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.

Journal Article Can J Anaesth · 2002 PURPOSE: Patients with hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this i ... Full text Link to item Cite

Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine.

Journal Article Anesth Analg · January 2002 UNLABELLED: Discharging patients with a long-acting peripheral nerve block remains controversial. Concerns about accidental injury of the limb or surgical site because of an insensate extremity are common despite a lack of data on the subject. We report a ... Full text Link to item Cite

Two forms of mitochondrial DNA ligase III are produced in Xenopus laevis oocytes.

Journal Article J Biol Chem · December 28, 2001 Full-length cDNAs for DNA ligase IV and the alpha and beta isoforms of DNA ligase III were cloned from Xenopus laevis to permit study of the genes encoding mitochondrial DNA ligase. DNA ligase III alpha and III beta share a common NH(2) terminus that encod ... Full text Link to item Cite

Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine.

Journal Article Anesth Analg · September 2001 Providing intraarticular analgesia with a continuous infusion of local anesthetic via a disposable infusion pump has gained popularity. Despite the prevalence of this technique, data comparing this method of analgesia to conventional regional anesthesia ar ... Full text Link to item Cite

Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade.

Journal Article Can J Anaesth · April 2001 PURPOSE: Major reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve blockade is an alternative method of pain control but is seldom used in the ambulatory setting. This case il ... Full text Link to item Cite

New murine cell line derived from a spontaneous lung tumor induces paraneoplastic syndromes.

Journal Article Int J Oncol · March 2001 LP07 is a new cell line derived from P07 lung tumor, spontaneously arisen in a BALB/c mouse. LP07 is composed of heterogeneous epithelioid polyhedric cells that proliferate at a slow rate, have low plating efficiency and are unable to grow in soft agar. On ... Full text Link to item Cite

Continuous peripheral nerve block for ambulatory surgery.

Journal Article Reg Anesth Pain Med · 2001 BACKGROUND AND OBJECTIVES: Continuous peripheral nerve block (CPNB) can provide surgical anesthesia, prolonged postoperative analgesia, and acceptable side effects. Despite these advantages, CPNB is not in widespread use. Recently a new CPNB catheter syste ... Full text Link to item Cite

Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump.

Journal Article Anesth Analg · December 2000 Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve bl ... Full text Link to item Cite

Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin: a comparison with anti-Xa concentrations.

Journal Article Anesth Analg · November 2000 UNLABELLED: Low molecular weight heparin (LMWH) is commonly used to prevent postoperative thromboembolism. Currently, there is no convenient test to measure the degree of anticoagulation from LMWH. This prospective study examines the relationship of thromb ... Full text Link to item Cite

Thoracic paravertebral block for breast surgery.

Journal Article Anesth Analg · June 2000 UNLABELLED: Cosmetic and reconstructive breast augmentation is a frequently performed surgical procedure. Despite advances in medical treatment, surgical intervention is often associated with postoperative pain, nausea, and vomiting. Paravertebral nerve bl ... Full text Link to item Cite

Anxiety, vocalization, and agitation following peripheral nerve block with ropivacaine.

Journal Article Reg Anesth Pain Med · 1999 BACKGROUND AND OBJECTIVES: Central nervous system (CNS) and cardiovascular toxicity are potential side effects of local anesthetics. However, ropivacaine has been reported to be less CNS toxic than bupivacaine in human volunteers. METHODS: We describe thre ... Full text Link to item Cite

Hemodynamic effects of peripheral nerve blocks for amputations of the lower extremity

Journal Article Regional Anesthesia and Pain Medicine · January 1, 1999 Objectives ; Patients with severe atherosclerosis frequently undergo lower limb amputations. A variety of anesthetic techniques have been used to minimize perioperative complications during these procedures including general anesthesia, neuroaxial anesthes ... Full text Cite

A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block.

Journal Article Anesth Analg · December 1998 UNLABELLED: The onset time and duration of action of ropivacaine during an interscalene block are not known. The potentially improved safety profile of ropivacaine may allow the use of higher concentrations to try and speed onset time. We compared bupivaca ... Full text Link to item Cite

Lumbar plexus and sciatic nerve block for knee arthroplasty: comparison of ropivacaine and bupivacaine.

Journal Article Can J Anaesth · November 1998 PURPOSE: Information about the onset time and duration of action of ropivacaine during a combined lumbar plexus and sciatic nerve block is not available. This study compares bupivacaine and ropivacaine to determine the optimal long-acting local anaesthetic ... Full text Link to item Cite

A new continuous catheter delivery system.

Journal Article Anesth Analg · July 1998 Full text Link to item Cite

Paravertebral somatic nerve block for outpatient inguinal herniorrhaphy: an expanded case report of 22 patients.

Journal Article Reg Anesth Pain Med · 1998 BACKGROUND AND OBJECTIVES: Inguinal herniorrhaphy is a common outpatient surgical procedure. However, anesthetic techniques for inguinal herniorrhaphy are still associated with numerous side effects. Paravertebral somatic nerve block (PSNB) has the potenti ... Full text Link to item Cite

Paravertebral somatic nerve block for outpatient inguinal herniorraphy

Journal Article Regional Anesthesia and Pain Medicine · January 1, 1998 Introduction. Inguinal herniorrhaphy is a common outpatient surgical procedure. However, anesthetic techniques for inguinal herniorrhaphy are still associated with numerous side effects. Nausea, vomiting, puritis, urinary retention and difficult pain manag ... Full text Cite

A teaching model for resident training in regional anesthesia

Journal Article Regional Anesthesia and Pain Medicine · January 1, 1998 Introduction: Despite an increasing demand for regional anesthesia techniques, most training programs probably fail to adequately train residents in this area ( 1,2). A major factor of inadequate training is the limited time a given resident actually spend ... Full text Cite

Safety and efficacy of supplementing interscalene blocks

Journal Article Regional Anesthesia · December 1, 1996 OBJECTIVES: Interscalene brachial plexus block is widely used for shoulder surgery. The benefits of this technique include excellent postoperative analgesia, decreased postoperative nausea, and early ambulation. However, these advantages may be lost if the ... Cite

Use of desflurane during resection of phaeochromocytoma

Journal Article British Journal of Anaesthesia · 1994 A patient underwent elective removal of a phaeochromocytoma producing extremely high plasma concentrations of catecholamines. The new volatile agent, desflurane, was incorporated, in varying concentrations, into the general anaesthetic regimen. ... Cite