Clinical Faculty

Karen C. Nielsen, MD

Assistant Professor of Anesthesiology

Department:
Anesthesiology

Division:
Anesthesiology

Mailing Address:
DUMC 3094 Durham, NC 27710

Office Telephone:
919-668-2051

Fax:
919-668-2081

Training:
MD, Federal University of Paraná, Brazil, 1995

Fellowship:
Ambulatory and Regional Anesthesia, Duke University Medical Center, 1999-2000

Residency:
Anesthesiology, Federal University of Paraná, Brazil, 1998

Clinical Interests:
Ambulatory and regional anesthesiology, acute pain management

Research Interests:
* 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

Publications:
Evans H, Nielsen KC, Steele SM. Regional Anesthesia for Ambulatory Surgery. Ambulatory Anesthesia Handbook. 2nd ed. Springer Science and Business Media, Inc; 2008: 195-223.

Shah A, Nielsen KC, Braga L, Pietrobon R, Klein SM, Steele SM.  Interscalene brachial plexus block for outpatient shoulder arthroplasty: postoperative analgesia, patient satisfaction, and complications. Indian Journal of Orthopaedics 2007; 41(3): 230-236.



Schlosser RJ, Nielsen KC, Evans H, Klein SM, Tucker SM, Steele SM. Peripheral Nerve Blocks for Outpatient Surgery. In: Hadzic A, Vloka J, eds. Regional Anesthesia: Principles & Practice.  1st ed. New York, NY: McGraw-Hill; 2007: 889-902.

Klein SM, Fronheiser MP, Reach J, Nielsen KC, Smith SW. Piezoelectric vibrating needle and catheter for enhancing ultrasound-guided peripheral nerve blocks. Anesth Analg. 2007 Dec;105(6):1858-60, table of contents.

Evans H, Nielsen KC, Greengrass RA, Steele SM. Equipment for Continuous Peripheral Nerve Blocks. In: Hadzic A, Vloka J, eds. Regional Anesthesia: Principles & Practice.  1st ed. New York, NY: McGraw-Hill; 2007: 631-647.



Vanterpool S, Steele SM, Nielsen KC, Tucker M, Klein SM. Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations. Reg Anesth Pain Med. 2006 Sep-Oct;31(5):417-21.

Schlosser RJ, Evans H, Nielsen KC, Klein SM, Tucker SM, Steele SM. Regional Anesthesia for Ambulatory Surgery. In: Hadzic A, Vloka J, eds. Regional Anesthesia: Principles & Practice.  1st ed. New York, NY: McGraw-Hill; In press Dec 2006.



Hanks RK, Pietrobon R, Nielsen KC, Steele SM, Tucker M, Warner DS, King KP, Klein SM. The effect of age on sciatic nerve block duration. Anesth Analg. 2006 Feb;102(2):588-92.

Evans H, Nielsen KC, Greengrass RA, Steele SM. Equipment for Continuous Peripheral Nerve Blocks. In: Hadzic A, Vloka J, eds. Regional Anesthesia: Principles & Practice.  1st ed. New York, NY: McGraw-Hill; In press Dec 2006.

Tucker MS, Nielsen KC, Steele SM. Nerve block induction rooms--physical plant setup, monitoring equipment, block cart, and resuscitation cart. Int Anesthesiol Clin. 2005;43(3):55-68.

Pietrobon R, Nielsen KC, Steele SM, Menezes AP, Martins H, Jacobs DO. Manuscript Architect: a Web application for scientific writing in virtual interdisciplinary groups. BMC Med Inform Decis Mak. 2005 Jun 16;5(1):15.

Nielsen KC, Tucker MS, Steele SM. Outcomes after regional anesthesia. Int Anesthesiol Clin. 2005;43(3):91-110.

Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA, Pietrobon R. Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks. Anesthesiology. 2005 Jan;102(1):181-7.

Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg. 2005 Dec;101(6):1663-76.

Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005 Dec;441:250-5.

Greengrass RA, Nielsen KC. Management of peripheral nerve block catheters at home. Int Anesthesiol Clin. 2005;43(3):79-87.

Ganapathy S, Nielsen KC, Steele SM. Outcomes after paravertebral blocks. Int Anesthesiol Clin. 2005;43(3):185-93.

Evans H, Steele SM, Nielsen KC, Tucker MS, Klein SM. Peripheral nerve blocks and continuous catheter techniques. Anesthesiol Clin North America. 2005 Mar;23(1):141-62.

Nielsen KC, Steele SM. Morbid and Super Morbid Obesity in Ambulatory Anesthesia. In: Steele SM, Nielsen KC, Klein SM, eds. Ambulatory Anesthesia and Perioperative Analgesia. 1st ed. New York, NY: McGraw-Hill; In press Dec 2004.

Nielsen KC, Steele SM. Ambulatory Evaluation and Safety Considerations. Tech Reg Anesth Pain Manag. 2004;8:99-103.

Nielsen KC, Steele SM. Ambulatory Anesthesia for Head and Neck Surgery. In: Steele SM, Nielsen KC, Klein SM, eds. Ambulatory Anesthesia and Perioperative Analgesia. 1st ed. New York, NY: McGraw-Hill; In press Dec 2004.



Klein SM, Eck J, Nielsen K, Steele SM. Anesthetizing the phantom: peripheral nerve stimulation of a nonexistent extremity. Anesthesiology. 2004;100:736-737.

Cotter JT, Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA, Pietrobon R. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery - an analysis of 9,342 blocks: [Un indice de masse corporelle eleve et un etat physique de classe IV selon l'ASA sont des facteurs de risque d'echec de l'anesthesie regionale ambulatoire - l'analyse de 9 342 cas]. Can J Anaesth. 2004 Oct;51(8):810-6.

Nielsen KC, Klein SM, Steele SM. Femoral Nerve Blocks. Techniques in Regional Anesthesia and Pain Management 2003 Jan;7(1):8-17.

Nielsen KC, Greengrass RA, Pietrobon R, Klein SM, Steele SM. Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases: [Le blocage interscalène continu du plexus brachial fournit une bonne analgésie à domicile après une opération majeure à l'épaule - observation de quatre cas]. Can J Anaesth. 2003 Jan;50(1):57-61.

Klein SM, Steele SM, Nielsen KC, Pietrobon R, Warner DS, Martin A, Greengrass RA. The difficulties of ambulatory interscalene and intra-articular infusions for rotator cuff surgery: a preliminary report. Can J Anaesth. 2003 Mar;50(3):265-9.

Klein SM, Pierce T, Rubin Y, Nielsen KC, Steele SM. Successful resuscitation after ropivacaine-induced ventricular fibrillation. Anesth Analg. 2003 Sep;97(3):901-3.

Klein SM, Nielsen KC. Brachial plexus blocks: infusions and other mechanisms to provide prolonged analgesia. Curr Opin Anaesthesiol. 2003 Aug;16(4):393-9.

Klein SM, Nielsen KC. Brachial Plexus Blocks: Infusions and Other Mechanisms to Provide Prolonged Analgesia. Current Opinion in Anaesthesiology, 200316:393-399.

Klein SM, Nielsen KC, Buckenmaier CC 3rd, Kamal AS, Rubin Y, Steele SM. 2-octyl cyanoacrylate glue for the fixation of continuous peripheral nerve catheters. Anesthesiology. 2003 Feb;98(2):590-1.

Klein SM, Dimitrov D, Steele SM, Nielsen KC, Warner DS, Martin A, Pietrobon R. Altered perceptions after upper and lower extremity blocks: an initial investigation. Reg Anesth Pain Med. 2003 Sep-Oct;28(5):433-8.

Kalady MF, Fields RC, Klein S, Nielsen KC, Mantyh CR, Ludwig KA. Loop ileostomy closure at an ambulatory surgery facility: a safe and cost-effective alternative to routine hospitalization.  Dis Colon Rectum.  2003 Apr;46(4):486-90.

Buckenmaier CC 3rd, Klein SM, Nielsen KC, Steele SM. Continuous paravertebral catheter and outpatient infusion for breast surgery. Anesth Analg. 2003 Sep;97(3):715-7.

Nielsen KC, Steele SM. Outcome after regional anaesthesia in the ambulatory setting--is it really worth it? Best Pract Res Clin Anaesthesiol. 2002 Jun;16(2):145-57.

Klein SM, Pietrobon R, Nielsen KC, Warner DS, Greengrass RA, Steele SM. Peripheral nerve blockade with long-acting local anesthetics: a survey of the Society for Ambulatory Anesthesia. Anesth Analg. 2002 Jan;94(1):71-6, table of contents.

Klein SM, Pietrobon R, Nielsen KC, Steele SM, Warner DS, Moylan JA, Eubanks WS, Greengrass RA. Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy. Reg Anesth Pain Med. 2002 Sep-Oct;27(5):476-80.

Klein SM, Nielsen KC, Greengrass RA, Warner DS, Martin A, Steele SM. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesth Analg. 2002 Jan;94(1):65-70, table of contents.

Greengrass RA, Steele SM, Moretti G, Grant SA, Klein SM, Nielsen KC. Peripheral Nerve Blocks. In P. Prithvi Raj, editor. Textbook of Regional Anesthesia. 1st ed. Philadelphia: Churchill Livingstone, 2002. p. 325-77.

Buckenmaier CC 3rd, Steele SM, Nielsen KC, Martin AH, Klein SM. Bilateral continuous paravertebral catheters for reduction mammoplasty. Acta Anaesthesiol Scand. 2002 Sep;46(8):1042-5.

Buckenmaier CC 3rd, Steele SM, Nielsen KC, Klein SM. Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy. Can J Anaesth. 2002 Jun-Jul;49(6):571-4.

Buckenmaier CC 3rd, Nielsen KC, Pietrobon R, Klein SM, Martin AH, Greengrass RA, Steele SM. Small-dose intrathecal lidocaine versus ropivacaine for anorectal surgery in an ambulatory setting. Anesth Analg. 2002 Nov;95(5):1253-7.

Soeding P, Hoy G, Klein SM, Nielsen KC, Steele SM. Intraarticular Analgesia in Shoulder Surgery [letter]. Anesth Analg 2001 Aug; 95(2):498.

Nielsen KC, Steele SM. Management of outpatient orthopedic surgery. Curr Opin Anaesthesiol. 2001 Dec;14(6):611-6.

Nielsen KC, Steele SM. Management of Outpatient Orthopedic Surgery. Current Opinion in Anaesthesiology 2001 Dec; 14(6): 611-6.

Klein SM, Nielsen KC, Martin A, White W, Warner DS, Steele SM, Speer KP, Greengrass RA. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesth Analg. 2001 Sep;93(3):601-5.

Klein SM, Greengrass RA, Nielsen KC, Steele SM. Difficult Insertion of Interscalene Brachial Plexus Catheter [letter]. Anesth Analg 2001 Apr; 92(4): 1074.

Klein SM, Greengrass RA, Grant SA, Higgins LD, Nielsen KC, Steele SM. Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade. Can J Anaesth. 2001 Apr;48(4):375-8.

Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein SM. Continuous peripheral nerve block for ambulatory surgery. Reg Anesth Pain Med. 2001 May-Jun;26(3):209-14.

Nielsen KC, Steele SM, Klein SM, Pietrobon RS, Greengrass RA. Continuous Interscalene Brachial Plexus Blockade at Home After Major Shoulder Surgery. Anesthesiology 2000 Sept; 93 (3A): A-15.

Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, White W, Warner DS, Steele SM. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesth Analg. 2000 Dec;91(6):1473-8.