Scholars@Duke
Karen Cristina Nielsen

Karen Cristina Nielsen

Associate Professor of Anesthesiology
Anesthesiology, Ambulatory
niels006@mc.duke.edu
Box 3094 Med Ctr, Durham, NC
2400 Pratt Street, North Pavi, Ste 3323, Durham, NC 27710

Selected Publications

Regional Anesthesia for Ambulatory Anesthesiologists.

Journal Article Anesthesiol Clin · June 2019 Proper pain control is critical for ambulatory surgery. Regional anesthesia can decrease postoperative pain, improve patient satisfaction, and expedite patient discharge. This article discusses the techniques, clinical pearls, and potential pitfalls associ ... Full text Link to item Cite

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

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.

Journal Article PLoS One · 2016 UNLABELLED: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients. This study evaluated the effect of dexamethasone on POCD incidence after noncardiac and nonneurologic surgery. METHODS: One hundre ... Full text 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

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

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

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

Diabetes mellitus, independent of body mass index, is associated with a "higher success" rate for supraclavicular brachial plexus blocks.

Journal Article Reg Anesth Pain Med · 2009 BACKGROUND AND OBJECTIVES: The prevalence of obesity and diabetes mellitus continues to rise in industrialized countries. The impact of diabetes on the practice of peripheral nerve block anesthesia, however, has not been fully elucidated. The authors retro ... Full text Link to item Cite

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

Journal Article Anesth Analg · December 2007 Featured Publication 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

The effect of age on sciatic nerve block duration.

Journal Article Anesth Analg · February 2006 Featured Publication 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 Featured Publication 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 Featured Publication 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

Regional anesthesia in hip surgery.

Journal Article Clin Orthop Relat Res · December 2005 UNLABELLED: Historically, general anesthesia has been the "gold standard" for surgeons and patients when major hip surgery is being done. The recent introductions of improved techniques and catheters for continuous peripheral nerve blocks have made regiona ... Full text Link to item Cite

A lesson learned.

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

Manuscript Architect: a Web application for scientific writing in virtual interdisciplinary groups.

Journal Article BMC Med Inform Decis Mak · June 16, 2005 Featured Publication BACKGROUND: Although scientific writing plays a central role in the communication of clinical research findings and consumes a significant amount of time from clinical researchers, few Web applications have been designed to systematically improve the writi ... Full text Link to item Cite

Peripheral nerve blocks and continuous catheter techniques.

Journal Article Anesthesiol Clin North Am · March 2005 Featured Publication 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

Management of peripheral nerve block catheters at home.

Journal Article Int Anesthesiol Clin · 2005 Featured Publication Full text Link to item Cite

Outcomes after paravertebral blocks.

Journal Article Int Anesthesiol Clin · 2005 Featured Publication Full text Link to item Cite

Outcomes after regional anesthesia.

Journal Article Int Anesthesiol Clin · 2005 Featured Publication 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 Featured Publication 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

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 Featured Publication 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

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 evaluation and safety considerations

Journal Article Techniques in Regional Anesthesia and Pain Management · January 1, 2004 The past few years have witnessed tremendous growth in the number and complexity of ambulatory surgical procedures. Despite these advances, postoperative pain remains a significant limiting factor to further expansion of outpatient surgery. Regional anesth ... Full text Cite

Successful resuscitation after ropivacaine-induced ventricular fibrillation.

Journal Article Anesth Analg · September 2003 Featured Publication 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 Featured Publication 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 Featured Publication 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 Featured Publication 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

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

Journal Article Can J Anaesth · March 2003 Featured Publication 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 Featured Publication 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 Featured Publication 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

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

Journal Article Anesth Analg · November 2002 Featured Publication 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 Featured Publication 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

Outcome after regional anaesthesia in the ambulatory setting--is it really worth it?

Journal Article Best Pract Res Clin Anaesthesiol · June 2002 Featured Publication Regional anaesthesia provides a continuum of perioperative care that includes perioperative pain management, decreased opioid requirements and decreased post-operative nausea and vomiting. In addition to these benefits, a wide variety of perioperative outc ... Full text Link to item Cite

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

Journal Article Anesth Analg · January 2002 Featured Publication 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 Featured Publication 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 Featured Publication 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 Featured Publication 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

Management of outpatient orthopedic surgery.

Journal Article Curr Opin Anaesthesiol · December 2001 Featured Publication The past few years have witnessed tremendous growth in the number and complexity of orthopedic surgical procedures performed on an outpatient basis. Despite these advances, postoperative pain remains a significant problem that may limit further expansion o ... Full text Link to item Cite

Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine.

Journal Article Anesth Analg · September 2001 Featured Publication 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 Featured Publication 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

Continuous peripheral nerve block for ambulatory surgery.

Journal Article Reg Anesth Pain Med · 2001 Featured Publication 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 Featured Publication 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