Risk of bias for each eligible study will be independent assessed by two reviewers using the criteria outlined in the Cochrane Handbook for Systematic Review of Interventions.52 For any study that includes multiple pain-related measures or interventions (eg, pain intensity or change in pain intensity), each measure will be assessed independently for risk of bias. Disagreements between the two reviewers will be resolved through discussion and consensus, and a third reviewer will be consulted if needed. Each category of bias will be assigned an unclear, low or high risk of bias and summarised in a risk of bias chart.

In each study, we will assess for the following risk of biases: (a) selection bias due to incomplete data collection, (b) incomplete outcome data due to lost to follow-up for risk for attrition bias, (c) selective reporting for detection bias, (d) number of participants for possible biases (eg, publication bias) that are confounded by small sample size, (e) information bias (including recall and observer biases) to address how data are obtained from study groups, which will be especially important for studies with non-randomised interventions and (f) confounding bias due to differences in comorbidities, demographic and surgical characteristics, baseline HRV differences, differences in analgesic use and other patient factors between study groups.

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