Karen Cristina Nielsen | Scholars@Duke

Karen Cristina Nielsen
Associate Professor of Anesthesiology

* The Use of Advanced Regional Anesthesia for Ambulatory Surgery:
The unique use of single injection and continuous peripheral nerve blocks has tremendous advantages for outpatients. This is the major focus of the textbook " Ambulatory Anesthesia and Perioperative Analgesia" (Editors Susan M. Steele, Karen C. Nielsen, Stephen M. Klein).

* Ambulatory Anesthesiology Database:
The ambulatory anesthesia database collects outcomes data for regional and ambulatory anesthesia. This database has proved that valuable data can be collected in an ambulatory setting resulting in continuous quality improvement, providing improved support for research and publications.

* Continuous Peripheral Nerve Blockade in the Ambulatory Setting:
Major surgical procedures on healthy and high risk patients (ASA III and IV) can be performed in an ambulatory setting due to continuous regional anesthetic techniques.

* Continuous Peripheral Nerve Blockade in the Home Setting:
Major surgical procedures can be performed in an ambulatory setting under continuous peripheral nerve blocks. Patients can be discharged on the same day of surgery with disposable infusion pumps connected to peripheral nerve catheters for 3 -4 days. Patient selection and education are critical for the success of this home catheter program. Close patient follow-up is performed via telephone calls. Excellent pain management has been achieved, with improved cognitive function and sleep profile. No complications have been reported.

* The Use of Paravertebral Somatic Nerve Blockade Technique for Breast Cancer Surgery:
Benefits of regional anesthesia for breast cancer treatment include excellent analgesia, decreased incidence of postoperative nausea and
vomiting, faster recovery, preservation of immunologic function, decreasing hospital stay, and generating cost savings. Continuous paravertebral block techniques have been used to extend postoperative analgesia.

* Outcomes after Ambulatory Regional Anesthesia

Current Appointments & Affiliations

Associate Professor of Anesthesiology, Anesthesiology, Ambulatory, Anesthesiology 2021

Contact Information

2400 Pratt Street, North Pavi, Durham, NC 27710
Box 3094 Med Ctr, Durham, NC 27710
niels006@mc.duke.edu (919) 668-2051

Background
Education, Training, & Certifications
- Fellow, Regional And Ambulatory Anesthesia, Duke University 1999 - 2000
- Resident, Anesthesiology, Federal University of Parana (Brazil) 1996 - 1998
- M.D., Federal University of Parana (Brazil) 1995
Previous Appointments & Affiliations
- Associate Professor of Anesthesiology, Anesthesiology, Ambulatory, Anesthesiology 2012 - 2020
- Assistant Professor of Anesthesiology, Anesthesiology, Ambulatory, Anesthesiology 2006 - 2012
- Assistant Clinical Professor of Anesthesiology, Anesthesiology, Ambulatory, Anesthesiology 2001 - 2006
- Associate in the Department of Anesthesiology, Anesthesiology, Ambulatory, Anesthesiology 2000 - 2001
- Visiting Associate in the Department of Anesthesiology, Anesthesiology, Clinical Science Departments 1999 - 2000
- Instructor, Temporary in the Department of Anesthesiology, Anesthesiology, Regional, Anesthesiology 1999
Expertise
Subject Headings
Publications & Artistic Works
Selected Publications
- Academic Articles
  - Nielsen, Karen C., M Stephen Melton, Ralf E. Gebhard, and Roy A. Greengrass. “Recurrence of breast cancer after anaesthesia.” Lancet 396, no. 10248 (August 8, 2020): 376. https://doi.org/10.1016/S0140-6736(20)30487-6.
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  - Gebhard, Ralf E., Karen C. Nielsen, Steve Melton, and Roy A. Greengrass. “Pectoralis-II Myofascial Block and Analgesia: Comment.” Anesthesiology 132, no. 6 (June 2020): 1602–4. https://doi.org/10.1097/ALN.0000000000003259.
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  - Ardon, Alberto E., Arun Prasad, Robert Lewis McClain, M Stephen Melton, Karen C. Nielsen, and Roy Greengrass. “Regional Anesthesia for Ambulatory Anesthesiologists.” Anesthesiol Clin 37, no. 2 (June 2019): 265–87. https://doi.org/10.1016/j.anclin.2019.01.005.
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  - Melton, M Stephen, Hanni E. Monroe, Wenjing Qi, Stephanie L. Lewis, Karen C. Nielsen, and Stephen M. Klein. “Effect of Interscalene Brachial Plexus Block on the Pulmonary Function of Obese Patients: A Prospective, Observational Cohort Study.” Anesth Analg 125, no. 1 (July 2017): 313–19. https://doi.org/10.1213/ANE.0000000000002180.
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  - Kim, James K., Amanda Kumar, Neda Sadeghi, Michael Shaughnessy, Jeff Gadsden, Karen C. Nielsen, M Steve Melton, and Stephen Klein. “Decreasing the Incidence of Tuohy-Borst Clamp Connector Disconnections From Perineural Catheters: A Quality Improvement Study.” Reg Anesth Pain Med 42, no. 6 (2017): 797–98. https://doi.org/10.1097/AAP.0000000000000655.
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  - Melton, M Stephen, Jeffrey N. Browndyke, Todd B. Harshbarger, David J. Madden, Karen C. Nielsen, and Stephen M. Klein. “Changes in Brain Resting-state Functional Connectivity Associated with Peripheral Nerve Block: A Pilot Study.” Anesthesiology 125, no. 2 (August 2016): 368–77. https://doi.org/10.1097/ALN.0000000000001198.
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  - Valentin, Livia Stocco Sanches, Valeria Fontenelle Angelim Pereira, Ricardo S. Pietrobon, Andre P. Schmidt, Jean P. Oses, Luis V. Portela, Diogo O. Souza, et al. “Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and General Anesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial.” Plos One 11, no. 5 (2016): e0152308. https://doi.org/10.1371/journal.pone.0152308.
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  - Melton, M Stephen, Karen C. Nielsen, Marcy Tucker, Stephen M. Klein, and Tong J. Gan. “Long-acting serotonin antagonist (Palonosetron) and the NK-1 receptor antagonists: does extended duration of action improve efficacy?” Anesthesiol Clin 32, no. 2 (June 2014): 505–16. https://doi.org/10.1016/j.anclin.2014.02.004.
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  - Melton, M Stephen, Karen C. Nielsen, Marcy Tucker, Stephen M. Klein, and Tong J. Gan. “New medications and techniques in ambulatory anesthesia.” Anesthesiol Clin 32, no. 2 (June 2014): 463–85. https://doi.org/10.1016/j.anclin.2014.02.003.
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  - Klein, Stephen M., M Steve Melton, Warren M. Grill, and Karen C. Nielsen. “Peripheral nerve stimulation in regional anesthesia.” Reg Anesth Pain Med 37, no. 4 (2012): 383–92. https://doi.org/10.1097/AAP.0b013e3182576647.
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  - Henderson, R. A., K. C. Nielsen, S. M. Klein, and R. Pietrobon. “Miscoding rates for professional anesthesia billing: Trial results - software solution.” Electronic Journal of Health Informatics 5, no. 2 (December 1, 2010).
  - Gan, Tong J., Keith A. Candiotti, Stephen M. Klein, Yiliam Rodriguez, Karen C. Nielsen, William D. White, and Ashraf S. Habib. “Double-blind comparison of granisetron, promethazine, or a combination of both for the prevention of postoperative nausea and vomiting in females undergoing outpatient laparoscopies.” Can J Anaesth 56, no. 11 (November 2009): 829–36. https://doi.org/10.1007/s12630-009-9175-x.
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  - Gebhard, Ralf E., Karen C. Nielsen, Ricardo Pietrobon, Andres Missair, and Brian A. Williams. “Diabetes mellitus, independent of body mass index, is associated with a "higher success" rate for supraclavicular brachial plexus blocks.” Reg Anesth Pain Med 34, no. 5 (2009): 404–7. https://doi.org/10.1097/AAP.0b013e3181ada58d.
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  - Klein, Stephen M., Matthew P. Fronheiser, John Reach, Karen C. Nielsen, and Stephen W. Smith. “Piezoelectric vibrating needle and catheter for enhancing ultrasound-guided peripheral nerve blocks.” Anesth Analg 105, no. 6 (December 2007): 1858–60. https://doi.org/10.1213/01.ane.0000286814.79988.0a.
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  - Shah, Anand, Karen C. Nielsen, Larissa Braga, Ricardo Pietrobon, Stephen M. Klein, and Susan M. Steele. “Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications.” Indian J Orthop 41, no. 3 (July 2007): 230–36. https://doi.org/10.4103/0019-5413.33688.
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  - Pietrobon, R., K. C. Nielsen, S. M. Steele, A. P. Menezes, H. Martins, and D. O. Jacobs. “Erratum: Manuscript Architect: A web application for scientific writing in virtual interdisciplinary groups (BMC Medical Informatics and Decision Making (2005) 5, 1, (15)).” Bmc Medical Informatics and Decision Making 7 (January 1, 2007). https://doi.org/10.1186/1472-6947-7-21.
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  - Hanks, R Kyle, Ricardo Pietrobon, Karen C. Nielsen, Susan M. Steele, Marcy Tucker, David S. Warner, Kathryn P. King, and Stephen M. Klein. “The effect of age on sciatic nerve block duration.” Anesth Analg 102, no. 2 (February 2006): 588–92. https://doi.org/10.1213/01.ane.0000189552.85175.db.
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  - Vanterpool, Stephanie, Susan M. Steele, Karen C. Nielsen, Marcy Tucker, and Stephen M. Klein. “Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations.” Reg Anesth Pain Med 31, no. 5 (2006): 417–21. https://doi.org/10.1016/j.rapm.2006.06.007.
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  - Klein, Stephen M., Holly Evans, Karen C. Nielsen, Marcy S. Tucker, David S. Warner, and Susan M. Steele. “Peripheral nerve block techniques for ambulatory surgery.” Anesth Analg 101, no. 6 (December 2005): 1663–76. https://doi.org/10.1213/01.ANE.0000184187.02887.24.
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  - Indelli, Pier Francesco, Stuart A. Grant, Karen Nielsen, and Thomas Parker Vail. “Regional anesthesia in hip surgery.” Clin Orthop Relat Res 441 (December 2005): 250–55. https://doi.org/10.1097/01.blo.0000192355.71966.8e.
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  - Todd, Michael M. “A lesson learned.” Anesthesiology 103, no. 2 (August 2005): 442. https://doi.org/10.1097/00000542-200508000-00029.
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  - Pietrobon, Ricardo, Karen C. Nielsen, Susan M. Steele, Andreia P. Menezes, Henrique Martins, and Danny O. Jacobs. “Manuscript Architect: a Web application for scientific writing in virtual interdisciplinary groups.” Bmc Med Inform Decis Mak 5 (June 16, 2005): 15. https://doi.org/10.1186/1472-6947-5-15.
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  - Evans, Holly, Susan M. Steele, Karen C. Nielsen, Marcy S. Tucker, and Stephen M. Klein. “Peripheral nerve blocks and continuous catheter techniques.” Anesthesiol Clin North Am 23, no. 1 (March 2005): 141–62. https://doi.org/10.1016/j.atc.2004.11.003.
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  - Ganapathy, Sugantha, Karen C. Nielsen, and Susan M. Steele. “Outcomes after paravertebral blocks.” Int Anesthesiol Clin 43, no. 3 (2005): 185–93. https://doi.org/10.1097/01.aia.0000166335.69251.06.
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  - Greengrass, Roy A., and Karen C. Nielsen. “Management of peripheral nerve block catheters at home.” Int Anesthesiol Clin 43, no. 3 (2005): 79–87. https://doi.org/10.1097/01.aia.0000166191.98814.59.
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  - Nielsen, Karen C., Marcy S. Tucker, and Susan M. Steele. “Outcomes after regional anesthesia.” Int Anesthesiol Clin 43, no. 3 (2005): 91–110. https://doi.org/10.1097/01.aia.0000166192.75943.33.
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  - Nielsen, Karen C., Ulrich Guller, Susan M. Steele, Stephen M. Klein, Roy A. Greengrass, and Ricardo Pietrobon. “Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks.” Anesthesiology 102, no. 1 (January 2005): 181–87. https://doi.org/10.1097/00000542-200501000-00027.
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  - Tucker, Marcy S., Karen C. Nielsen, and Susan M. Steele. “Nerve block induction rooms--physical plant setup, monitoring equipment, block cart, and resuscitation cart.” Int Anesthesiol Clin 43, no. 3 (2005): 55–68. https://doi.org/10.1097/01.aia.0000166189.91190.7d.
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  - Todd, Michael M. “A lesson learned.” Can J Anaesth 52, no. 7 (2005): 770–71. https://doi.org/10.1007/BF03016568.
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  - Cotter, Juliann T., Karen C. Nielsen, Ulrich Guller, Susan M. Steele, Stephen M. Klein, Roy A. Greengrass, and Ricardo Pietrobon. “Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery - an analysis of 9,342 blocks.” Can J Anaesth 51, no. 8 (October 2004): 810–16. https://doi.org/10.1007/BF03018454.
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  - Klein, Stephen M., John Eck, Karen Nielsen, and Susan M. Steele. “Anesthetizing the phantom: peripheral nerve stimulation of a nonexistent extremity.” Anesthesiology 100, no. 3 (March 2004): 736–37. https://doi.org/10.1097/00000542-200403000-00039.
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  - Nielsen, K. C., and S. M. Steele. “Ambulatory evaluation and safety considerations.” Techniques in Regional Anesthesia and Pain Management 8, no. 2 (January 1, 2004): 99–103. https://doi.org/10.1053/j.trap.2003.12.001.
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  - Klein, Stephen M., Karen C. Nielsen, Nadeem Ahmed, Chester C. Buckenmaier, and Susan M. Steele. “In situ images of the thoracic paravertebral space.” Reg Anesth Pain Med 29, no. 6 (2004): 596–99. https://doi.org/10.1016/j.rapm.2004.08.016.
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  - Paqueron, Xavier, and Marc E. Gentili. “Assessing phantom limb sensations... and the library?” Reg Anesth Pain Med 29, no. 2 (2004): 172–73. https://doi.org/10.1016/j.rapm.2003.12.005.
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  - Buckenmaier, Chester C., Stephen M. Klein, Karen C. Nielsen, and Susan M. Steele. “Continuous paravertebral catheter and outpatient infusion for breast surgery.” Anesth Analg 97, no. 3 (September 2003): 715–17. https://doi.org/10.1213/01.ANE.0000075836.53838.EB.
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  - Klein, Stephen M., Trenton Pierce, Yair Rubin, Karen C. Nielsen, and Susan M. Steele. “Successful resuscitation after ropivacaine-induced ventricular fibrillation.” Anesth Analg 97, no. 3 (September 2003): 901–3. https://doi.org/10.1213/01.ANE.0000075839.18073.37.
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  - Klein, Stephen M., and Karen C. Nielsen. “Brachial plexus blocks: infusions and other mechanisms to provide prolonged analgesia.” Curr Opin Anaesthesiol 16, no. 4 (August 2003): 393–99. https://doi.org/10.1097/01.aco.0000084477.59960.92.
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  - Kalady, Matthew F., Ryan C. Fields, Stephen Klein, Karen C. Nielsen, Christopher R. Mantyh, and Kirk A. Ludwig. “Loop ileostomy closure at an ambulatory surgery facility: a safe and cost-effective alternative to routine hospitalization.” Dis Colon Rectum 46, no. 4 (April 2003): 486–90. https://doi.org/10.1007/s10350-004-6587-0.
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  - Klein, Stephen M., Susan M. Steele, Karen C. Nielsen, Ricardo Pietrobon, David S. Warner, Aliki Martin, and Roy A. Greengrass. “The difficulties of ambulatory interscalene and intra-articular infusions for rotator cuff surgery: a preliminary report.” Can J Anaesth 50, no. 3 (March 2003): 265–69. https://doi.org/10.1007/BF03017796.
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  - Klein, Stephen M., Karen C. Nielsen, Chester C. Buckenmaier, Adil S. A. Kamal, Yair Rubin, and Susan M. Steele. “2-octyl cyanoacrylate glue for the fixation of continuous peripheral nerve catheters.” Anesthesiology 98, no. 2 (February 2003): 590–91. https://doi.org/10.1097/00000542-200302000-00049.
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  - Nielsen, K. C., S. M. Klein, and S. M. Steele. “Femoral nerve blocks.” Techniques in Regional Anesthesia and Pain Management 7, no. 1 (January 1, 2003): 8–17. https://doi.org/10.1053/trap.2003.123518.
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  - Klein, Stephen M., Dragan Dimitrov, Susan M. Steele, Karen C. Nielsen, David S. Warner, Aliki Martin, and Ricardo Pietrobon. “Altered perceptions after upper and lower extremity blocks: an initial investigation.” Reg Anesth Pain Med 28, no. 5 (2003): 433–38. https://doi.org/10.1016/s1098-7339(03)00233-5.
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  - Nielsen, Karen C., Roy A. Greengrass, Ricardo Pietrobon, Stephen M. Klein, and Susan M. Steele. “Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases.” Can J Anaesth 50, no. 1 (January 2003): 57–61. https://doi.org/10.1007/BF03020188.
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  - Buckenmaier, Chester C., Karen C. Nielsen, Ricardo Pietrobon, Stephen M. Klein, Aliki H. Martin, Roy A. Greengrass, and Susan M. Steele. “Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting.” Anesth Analg 95, no. 5 (November 2002): 1253–57. https://doi.org/10.1097/00000539-200211000-00028.
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  - Buckenmaier, C. C., S. M. Steele, K. C. Nielsen, A. H. Martin, and S. M. Klein. “Bilateral continuous paravertebral catheters for reduction mammoplasty.” Acta Anaesthesiol Scand 46, no. 8 (September 2002): 1042–45. https://doi.org/10.1034/j.1399-6576.2002.460820.x.
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  - Soeding, P., and G. Hoy. “Intraarticular analgesia in shoulder surgery.” Anesth Analg 95, no. 2 (August 2002): 498.
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  - Nielsen, Karen C., and Susan M. Steele. “Outcome after regional anaesthesia in the ambulatory setting--is it really worth it?” Best Pract Res Clin Anaesthesiol 16, no. 2 (June 2002): 145–57. https://doi.org/10.1053/bean.2002.0244.
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  - Klein, Stephen M., Karen C. Nielsen, Roy A. Greengrass, David S. Warner, Aliki Martin, and Susan M. Steele. “Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine.” Anesth Analg 94, no. 1 (January 2002): 65–70. https://doi.org/10.1097/00000539-200201000-00012.
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  - Klein, Stephen M., Ricardo Pietrobon, Karen C. Nielsen, David S. Warner, Roy A. Greengrass, and Susan M. Steele. “Peripheral nerve blockade with long-acting local anesthetics: a survey of the Society for Ambulatory Anesthesia.” Anesth Analg 94, no. 1 (January 2002): 71–76. https://doi.org/10.1097/00000539-200201000-00013.
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  - Buckenmaier, Chester C., Susan M. Steele, Karen C. Nielsen, and Stephen M. Klein. “Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy.” Can J Anaesth 49, no. 6 (2002): 571–74. https://doi.org/10.1007/BF03017383.
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  - Klein, Stephen M., Ricardo Pietrobon, Karen C. Nielsen, Susan M. Steele, David S. Warner, Joseph A. Moylan, W Steve Eubanks, and Roy A. Greengrass. “Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy.” Reg Anesth Pain Med 27, no. 5 (2002): 476–80. https://doi.org/10.1053/rapm.2002.35147.
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  - Nielsen, K. C., and S. M. Steele. “Management of outpatient orthopedic surgery.” Curr Opin Anaesthesiol 14, no. 6 (December 2001): 611–16. https://doi.org/10.1097/00001503-200112000-00002.
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  - Klein, S. M., K. C. Nielsen, A. Martin, W. White, D. S. Warner, S. M. Steele, K. P. Speer, and R. A. Greengrass. “Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine.” Anesth Analg 93, no. 3 (September 2001): 601–5. https://doi.org/10.1097/00000539-200109000-00015.
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  - Klein, S. M., R. A. Greengrass, S. A. Grant, L. D. Higgins, K. C. Nielsen, and S. M. Steele. “Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade.” Can J Anaesth 48, no. 4 (April 2001): 375–78. https://doi.org/10.1007/BF03014966.
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  - Singelyn, F. J. “Difficult insertion of interscalene brachial plexus catheter.” Anesth Analg 92, no. 4 (April 2001): 1074. https://doi.org/10.1097/00000539-200104000-00056.
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  - Grant, S. A., K. C. Nielsen, R. A. Greengrass, S. M. Steele, and S. M. Klein. “Continuous peripheral nerve block for ambulatory surgery.” Reg Anesth Pain Med 26, no. 3 (2001): 209–14. https://doi.org/10.1053/rapm.2001.22256.
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  - Klein, S. M., S. A. Grant, R. A. Greengrass, K. C. Nielsen, K. P. Speer, W. White, D. S. Warner, and S. M. Steele. “Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump.” Anesth Analg 91, no. 6 (December 2000): 1473–78. https://doi.org/10.1097/00000539-200012000-00033.
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- Book Sections
  - Evans, H., K. C. Nielsen, M. S. Tucker, and S. M. Klein. “Regional anesthesia for acute pain management in the outpatient setting.” In Acute Pain Management, 287–301, 2009. https://doi.org/10.1017/CBO9780511576706.019.
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Education, Training, & Certifications

Previous Appointments & Affiliations

Subject Headings

Selected Publications

Academic Articles

Book Sections