Physicians

Department / Division
Anesthesiology / Anesthesiology-Ambulatory Division

Address
DUMC 3094
Durham, NC 27710

Office Telephone
919-668-2051

Fax Telephone
919-668-2081

Training

• MD, Federal University of Paraná (Brazil), 1995

Residency

• Anesthesiology, Federal University of Paraná (Brazil), 1998

Fellowship

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

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

Industry Relationships and Collaborations (What's this?)

This faculty member (or a member of their immediate family) has a working relationship (i.e. consulting, research, and/or educational services) with the companies listed below. These relations have been reported to the health system leadership and, when appropriate, management plans are in place to address potential conflicts.

• IFlow - A Kimberly Clark Health Care Company
• McGraw Hill Publishing
• Omeros Corporation
• The Henry M. Jackson Foundation for the Advancement of Military Medicine

Representative Publications
Klein, SM; Fronheiser, MP; Reach, J; Nielsen, KC; Smith, SW. Piezoelectric vibrating needle and catheter for enhancing ultrasound-guided peripheral nerve blocks. Anesthesia and Analgesia. 2007;105:1858-1860. (2007) Abstract

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. Anesthesia and Analgesia. 2006;102:588-592. (2006) Abstract

Vanterpool, S; Steele, SM; Nielsen, KC; Tucker, M; Klein, SM. Combined lumbar-plexus and sciatic-nerve blocks: an analysis of plasma ropivacaine concentrations. Regional Anesthesia and Pain Medicine. 2006;31:417-421. (2006) Abstract

Evans, H; Steele, SM; Nielsen, KC; Tucker, MS; Klein, SM. Peripheral nerve blocks and continuous catheter techniques. Anesthesiology Clinics. 2005;23:141-162. (2005) Abstract

Ganapathy, S; Nielsen, KC; Steele, SM. Outcomes after paravertebral blocks. International Anesthesiology Clinics. 2005;43:185-193. (2005) Abstract

Greengrass, RA; Nielsen, KC. Management of peripheral nerve block catheters at home. International Anesthesiology Clinics. 2005;43:79-87. (2005) Abstract

Klein, SM; Evans, H; Nielsen, KC; Tucker, MS; Warner, DS; Steele, SM. Peripheral nerve block techniques for ambulatory surgery. Anesthesia and Analgesia. 2005;101:1663-1676. (2005) Abstract

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;102:181-187. (2005) Abstract

Nielsen, KC; Tucker, MS; Steele, SM. Outcomes after regional anesthesia. International Anesthesiology Clinics. 2005;43:91-110. (2005) Abstract

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 Medical Informatics and Decision Making. 2005;5:15. (2005) Abstract

Tucker, MS; Nielsen, KC; Steele, SM. Nerve block induction rooms--physical plant setup, monitoring equipment, block cart, and resuscitation cart. International Anesthesiology Clinics. 2005;43:55-68. (2005) Abstract

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. Canadian Journal of Anaesthesia. 2004;51:810-816. (2004) Abstract

Buckenmaier, CC; Klein, SM; Nielsen, KC; Steele, SM. Continuous paravertebral catheter and outpatient infusion for breast surgery. Anesthesia and Analgesia. 2003;97:715-717. (2003) Abstract

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. Diseases of the Colon and Rectum. 2003;46:486-490. (2003) Abstract

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. Regional Anesthesia and Pain Medicine. 2003;28:433-438. (2003) Abstract

Klein, SM; Nielsen, KC. Brachial plexus blocks: infusions and other mechanisms to provide prolonged analgesia. Current Opinion in Anaesthesiology. 2003;16:393-399. (2003) Abstract

Klein, SM; Nielsen, KC; Buckenmaier, CC; Kamal, AS; Rubin, Y; Steele, SM. 2-octyl cyanoacrylate glue for the fixation of continuous peripheral nerve catheters. Anesthesiology. 2003;98:590-591. (2003) Abstract

Klein, SM; Pierce, T; Rubin, Y; Nielsen, KC; Steele, SM. Successful resuscitation after ropivacaine-induced ventricular fibrillation. Anesthesia and Analgesia. 2003;97:901-903. (2003) Abstract

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. Canadian Journal of Anaesthesia. 2003;50:265-269. (2003) Abstract

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. Canadian Journal of Anaesthesia. 2003;50:57-61. (2003) Abstract

Buckenmaier, CC; 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. Anesthesia and Analgesia. 2002;95:1253-1257. (2002) Abstract

Buckenmaier, CC; Steele, SM; Nielsen, KC; Klein, SM. Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy. Canadian Journal of Anaesthesia. 2002;49:571-574. (2002) Abstract

Buckenmaier, CC; Steele, SM; Nielsen, KC; Martin, AH; Klein, SM. Bilateral continuous paravertebral catheters for reduction mammoplasty. Acta Anaesthesiologica Scandinavica: an international journal of anaesthesiology and intensive care, pain and emergency medicine. 2002;46:1042-1045. (2002) Abstract

Klein, SM; Nielsen, KC; Greengrass, RA; Warner, DS; Martin, A; Steele, SM. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesthesia and Analgesia. 2002;94:65-70. (2002) Abstract

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. Regional Anesthesia and Pain Medicine. 2002;27:476-480. (2002) Abstract

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. Anesthesia and Analgesia. 2002;94:71-76. (2002) Abstract

Nielsen, KC; Steele, SM. Outcome after regional anaesthesia in the ambulatory setting--is it really worth it?. Bailliere's Best Practice and Research in Clinical Anaesthesiology. 2002;16:145-157. (2002) Abstract

Grant, SA; Nielsen, KC; Greengrass, RA; Steele, SM; Klein, SM. Continuous peripheral nerve block for ambulatory surgery. Regional Anesthesia and Pain Medicine. 2001;26:209-214. (2001) Abstract

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. Canadian Journal of Anaesthesia. 2001;48:375-378. (2001) Abstract

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. Anesthesia and Analgesia. 2001;93:601-605. (2001) Abstract

Nielsen, KC; Steele, SM. Management of outpatient orthopedic surgery. Current Opinion in Anaesthesiology. 2001;14:611-616. (2001) Abstract

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. Anesthesia and Analgesia. 2000;91:1473-1478. (2000) Abstract