{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:58:35Z","timestamp":1784368715332,"version":"3.55.0"},"reference-count":52,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T00:00:00Z","timestamp":1618272000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CIHR SPOR Chronic Pain Network"],"award-info":[{"award-number":["CIHR SPOR Chronic Pain Network"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,3,30]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Surgical interventions can elicit neuroendocrine responses and sympathovagal imbalance, ultimately affecting cardiac autonomic function. Cardiac complications account for 30% of postoperative complications and are the leading cause of morbidity and mortality following non-cardiac surgery. One cardiovascular parameter, heart rate variability (HRV), has been found to be predictive of postoperative morbidity and mortality. HRV is defined as variation in time intervals between heartbeats and is affected by cardiac autonomic balance. Furthermore, altered HRV has been shown to predict cardiovascular events in non-surgical settings. In multiple studies, experimentally induced pain in healthy humans leads to reduced HRV suggesting a causal relationship. In a different studies, chronic pain has been associated with altered HRV, however, in the setting of clinical pain conditions, it remains unclear how much HRV impairment is due to pain itself versus autonomic changes related to analgesia. We aim to review the available evidence describing the association between postsurgical pain and HRV alterations in the early postoperative period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a scoping review of relevant studies using detailed searches of MEDLINE and EMBASE, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Included studies will involve participants undergoing non-cardiac surgery and investigate outcomes of (1) measures of pain intensity; (2) measures of HRV and (3) statistical assessment of association between #1 and #2. As secondary review outcomes included studies will also be examined for other cardiovascular events and for their attempts to control for analgesic treatment and presurgical HRV differences among treatment groups in the analysis. This work aims to synthesise available evidence to inform future research questions related to postsurgical pain and cardiac complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics review and approval is not required for this review. The results will be submitted for publication in peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-044949","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T14:06:59Z","timestamp":1618322819000},"page":"e044949","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Association between postsurgical pain and heart rate variability: protocol for a scoping review"],"prefix":"10.1136","volume":"11","author":[{"given":"Vincent","family":"So","sequence":"first","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Klar","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Leitch","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"McGillion","sequence":"additional","affiliation":[{"name":"School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P J","family":"Devereaux","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramiro","family":"Arellano","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Parlow","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Queen\u2019s University, Kingston, Ontario, Canada"},{"name":"Departments of Biomedical and Molecular Sciences, Queen\u2019s University Faculty of Health Sciences, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-8792","authenticated-orcid":false,"given":"Ian","family":"Gilron","sequence":"additional","affiliation":[{"name":"Anesthesiology and Perioperative Medicine, Queen\u2019s University, Kingston, Ontario, Canada"},{"name":"Departments of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queen\u2019s University Faculty of Health Sciences, Kingston, Ontario, Canada"},{"name":"School of Policy Studies, Queen\"s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"2025121513510010000_11.4.e044949.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60878-8"},{"key":"2025121513510010000_11.4.e044949.2","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/anae.14138","article-title":"Cardiovascular complications after non-cardiac surgery","volume":"73","author":"Sellers","year":"2018","journal-title":"Anaesthesia"},{"key":"2025121513510010000_11.4.e044949.3","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000287654.49358.3a"},{"key":"2025121513510010000_11.4.e044949.4","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000113"},{"key":"2025121513510010000_11.4.e044949.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0810119"},{"key":"2025121513510010000_11.4.e044949.6","first-page":"2383","article-title":"ESC\/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint Task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesth","volume":"2014","author":"Kristensen","year":"2014","journal-title":"Eur Heart J"},{"key":"2025121513510010000_11.4.e044949.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1502824"},{"key":"2025121513510010000_11.4.e044949.8","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/85.1.109"},{"key":"2025121513510010000_11.4.e044949.9","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/2047487318798925","article-title":"Causes and prevention of postoperative myocardial injury","volume":"26","author":"Verbree-Willemsen","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"2025121513510010000_11.4.e044949.10","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002560"},{"key":"2025121513510010000_11.4.e044949.11","doi-asserted-by":"crossref","unstructured":"Devereaux PJ , Szczeklik W . 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