{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:22:50Z","timestamp":1787775770895,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>\n                      Intrathecal anaesthesia is widely used for infraumbilical surgeries due to its effectiveness in providing pain relief during and after the operation. Adding magnesium sulphate (MgSO\n                      <jats:sub>4<\/jats:sub>\n                      ) to intrathecal local anaesthetics can prolong analgesia, reduce postoperative analgesic requirements and improve the management of shivering perioperatively. This review aims to investigate the use of intrathecal adjuvant MgSO4 for anaesthesia in infraumbilical surgeries.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We performed a meta-analysis (PROSPERO ID: CRD42023432378) of trials, which included patients who underwent a variety of surgical procedures under spinal anaesthesia with intrathecal MgSO\n                      <jats:sub>4<\/jats:sub>\n                      as an adjuvant to spinal local anaesthetics. The analysed outcomes included sensory and motor effects and adverse effects. We presented dichotomous outcomes as risk ratios with 95% confidence intervals (CI), while continuous outcomes were measured as mean differences (MDs) with 95% CI. We considered the results significant if the\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value was &lt; 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-two studies (2379 patients) were included. Adding intrathecal MgSO\n                      <jats:sub>4<\/jats:sub>\n                      to bupivacaine significantly prolonged the time for regression of two segments from the maximum height (MD: 27.18 min; 95% CI: 12.56, 41.79;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0003), delayed the onset of sensory block to T10 (MD: 1.93 min; 95% CI: 1.10, 2.77;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001), prolonged the duration of motor block (Bromage score = 0) (MD: 15.13 min; 95% CI: 4.59, 25.66;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005) and extended time for first rescue analgesia (MD: 43.80 min; 95% CI: 26.47, 61.14;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.00001). No significant effect for MgSO\n                      <jats:sub>4<\/jats:sub>\n                      on side effects was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      Our review underscores intrathecal MgSO\n                      <jats:sub>4<\/jats:sub>\n                      \u2019s benefits in prolonging block duration and improving pain management, but highlights significant heterogeneity, limiting the strength of these findings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_862_24","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T10:00:11Z","timestamp":1736589611000},"page":"86-107","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Intrathecal magnesium sulphate as an adjuvant to bupivacaine for infraumbilical surgeries: An updated systematic review and meta-analysis"],"prefix":"10.4103","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8688-0349","authenticated-orcid":false,"given":"Mohamed Mohamed","family":"Belal","sequence":"first","affiliation":[{"name":"Intern Doctor, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7881-9321","authenticated-orcid":false,"given":"Osama Mohammad","family":"Alazki","sequence":"additional","affiliation":[{"name":"Department Of Oncology, Faculty of Medicine, Tishreen University, Latakia, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-5515","authenticated-orcid":false,"given":"Mohamed Nabih","family":"Bashir","sequence":"additional","affiliation":[{"name":"Intern Doctor, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-9709","authenticated-orcid":false,"given":"Lana Yousef","family":"Sbitan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, Jordan"},{"name":"Department of General Surgery, Prince Hamza Hospital, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7899-8438","authenticated-orcid":false,"given":"Douaa","family":"Albelal","sequence":"additional","affiliation":[{"name":"General Practitioner, Faculty of Medicine, Hama University, Hama, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4593-3499","authenticated-orcid":false,"given":"Farah","family":"Albakkar","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, University of Aleppo, Aleppo, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-3885","authenticated-orcid":false,"given":"Abdelrahmanh H.","family":"Hafez","sequence":"additional","affiliation":[{"name":"Department of Cardiology Faculty of Medicine, Al-Azhar University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8858-093X","authenticated-orcid":false,"given":"Ayman Issa","family":"Nabhan","sequence":"additional","affiliation":[{"name":"General Practitioner, Faculty of Medicine, Al Andalus University for Medical Sciences, Tartus, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"key":"R3-20250111","doi-asserted-by":"crossref","first-page":"495","DOI":"10.4103\/0970-9185.86594","article-title":"Comparative study of intrathecal dexmedetomidine with intrathecal magnesium sulfate used as adjuvants to bupivacaine","volume":"27","author":"Shukla","year":"2011","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R4-20250111","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0304-3959(91)90100-C","article-title":"The induction and maintenance of central sensitization is dependent on N -methyl-d-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states","volume":"44","author":"Woolf","year":"1991","journal-title":"Pain"},{"key":"R5-20250111","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.3390\/nu12082184","article-title":"Magnesium and pain","volume":"12","author":"Shin","year":"2020","journal-title":"Nutrients"},{"key":"R6-20250111","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ijoa.2009.08.007","article-title":"A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section","volume":"19","author":"Malleeswaran","year":"2010","journal-title":"Int J Obstet Anesth"},{"key":"R7-20250111","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/bja\/aet064","article-title":"Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: A systematic review and meta-analysis","volume":"110","author":"Morrison","year":"2013","journal-title":"Br J Anaesth"},{"key":"R8-20250111","first-page":"667","article-title":"Intrathecal magnesium as analgesic adjuvant for spinal anesthesia: A meta-analysis of randomized trials","volume":"79","author":"Pascual-Ram\u00edrez","year":"2013","journal-title":"Minerva Anestesiol"},{"key":"R9-20250111","doi-asserted-by":"crossref","first-page":"e22524","DOI":"10.1097\/MD.0000000000022524","article-title":"The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anesthesia: A meta-analysis of randomized controlled trials","volume":"99","author":"Wang","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"R10-20250111","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R11-20250111","doi-asserted-by":"crossref","first-page":"e96407","DOI":"10.1371\/journal.pone.0096407","article-title":"Blinded by PRISMA: Are systematic reviewers focusing on PRISMA and ignoring other guidelines?","volume":"9","author":"Fleming","year":"2014","journal-title":"PLoS One"},{"key":"R12-20250111","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3163\/1536-5050.104.3.014","article-title":"De-duplication of database search results for systematic reviews in EndNote","volume":"104","author":"Bramer","year":"2016","journal-title":"J Med Libr Assoc"},{"key":"R13-20250111","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"R14-20250111","first-page":"1436","article-title":"[Bias risk assessment: (3) Revised Cochrane bias risk assessment tool for individual randomized, cross-over trials (RoB2.0)]","volume":"38","author":"Wu","year":"2017","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"R15-20250111","first-page":"42","article-title":"Magnesium sulphate and dexmedetomidine used intrathecally as adjuvant to bupivacaine: A study","volume":"6","author":"Farooq","year":"2017","journal-title":"Int J Med Res Health Sci"},{"key":"R16-20250111","first-page":"1650","article-title":"Comparison of post operative analgesia and haemodynamic change of 0.5% hyperbaric bupivacaine, 0.5% hyperbaric bupivacaine with clonidine and 0.5% hyperbaric bupivacaine with magnesium sulphate in lower abdominal surgical procedure under spinal anaesthesia","volume":"13","author":"Raghuvanshi","year":"2022","journal-title":"J Cardiovasc Dis Res"},{"key":"R17-20250111","first-page":"3783","article-title":"The adjunctive midazolam or magnesium sulfate to intrathecal bupivacaine analgesic effect in caesarean section: A randomized controlled trial","volume":"28","author":"Zakeri","year":"2017","journal-title":"Biomed Res"},{"key":"R18-20250111","doi-asserted-by":"crossref","first-page":"364","DOI":"10.4103\/0259-1162.159764","article-title":"Intrathecal magnesium sulfate as a spinal adjuvant in two different doses, combined with 0.5% heavy bupivacaine for infraumbilical surgeries","volume":"9","author":"Yadav","year":"2015","journal-title":"Anesth Essays Res"},{"key":"R19-20250111","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/6148782","article-title":"Comparing the analgesic efficacy of intrathecal bupivacaine alone with intrathecal bupivacaine midazolam or magnesium sulphate combination in patients undergoing elective infraumbilical surgery","volume":"2016","author":"Attia","year":"2016","journal-title":"J Anesthesiol"},{"key":"R20-20250111","doi-asserted-by":"crossref","first-page":"185","DOI":"10.2165\/00023210-200721030-00002","article-title":"Perioperative pain management","volume":"21","author":"Pyati","year":"2007","journal-title":"CNS Drugs"},{"key":"R21-20250111","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/AJP.0000000000000944","article-title":"The use of magnesium sulfate and peripheral nerve blocks","volume":"37","author":"Zeng","year":"2021","journal-title":"Clin J Pain"},{"key":"R22-20250111","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13018-021-02264-1","article-title":"Intra-articular magnesium to alleviate postoperative pain after arthroscopic knee surgery: A meta-analysis of randomized controlled trials","volume":"16","author":"Shi","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"R23-20250111","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1186\/s13018-021-02609-w","article-title":"The effect of magnesium added to bupivacaine for arthroscopy: A meta-analysis of randomized controlled trials","volume":"16","author":"Xiang","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"R24-20250111","doi-asserted-by":"crossref","first-page":"e13583","DOI":"10.1097\/MD.0000000000013583","article-title":"The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery","volume":"97","author":"Peng","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"R25-20250111","first-page":"e58","article-title":"Intra-operative adjunctive magnesium sulfate in pain management of total knee arthroplasty; a systematic review and meta-analysis","volume":"11","author":"Azimi","year":"2023","journal-title":"Arch Acad Emerg Med"},{"key":"R26-20250111","doi-asserted-by":"crossref","first-page":"416","DOI":"10.4103\/1687-7934.189098","article-title":"Magnesium sulfate at two different doses as an adjuvant to bupivacaine in infraumblical (below knee) orthopedic surgeries under spinal anesthesia","volume":"9","author":"Chaudhary","year":"2016","journal-title":"Ain-Shams J Anaesthesiol"},{"key":"R27-20250111","doi-asserted-by":"crossref","first-page":"230","DOI":"10.4103\/1687-7934.156696","article-title":"Comparison of intrathecal magnesium, dexmedetomidine, or placebo combined with bupivacaine 0.5% for patients with mild pre-eclampsia undergoing cesarean section","volume":"8","author":"Elie","year":"2015","journal-title":"Ain-Shams J Anaesthesiol"},{"key":"R28-20250111","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/2277-9175.94430","article-title":"Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial","volume":"1","author":"Jabalameli","year":"2012","journal-title":"Adv Biomed Res"},{"key":"R29-20250111","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/JOACC.JOACC_35_22","article-title":"Comparison of two different doses of magnesium sulfate as an adjuvant to intrathecal bupivacaine in patients with pre-eclampsia undergoing elective cesarean section: A prospective double-blind randomized study","volume":"13","author":"Tuteja","year":"2023","journal-title":"J Obstet Anaesth Crit Care"},{"key":"R30-20250111","first-page":"376","article-title":"A Prospective Randomized Assessment of the Intrathecal Dexmedetomedine and Magnesium Sulfate as Adjuvants to Bupivacaine in Total Hip Replacement","volume":"14","author":"Madhukant,","year":"2022","journal-title":"Int J Pharm Clin Res"},{"key":"R31-20250111","first-page":"2893","article-title":"A Comparison Study of Adding Magnesium Sulfate to Local Anesthetics During Spinal Anesthesia for Cesarean Section","volume":"15","author":"Alkhazraji","year":"2021","journal-title":"Indian J Forensic Med Toxicol"},{"key":"R32-20250111","first-page":"182","article-title":"Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double-blind study","volume":"24","author":"Mostafa","year":"2020","journal-title":"Eur J Pain (United Kingdom)"},{"key":"R33-20250111","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12871-019-0853-0","article-title":"Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT)","volume":"19","author":"Omar","year":"2019","journal-title":"BMC Anesthesiol"},{"key":"R34-20250111","first-page":"1133","article-title":"an Experimental Study Comparing Intrathecal Dexmedetomidine With Intrathecal Magnesium Sulphate As Bupivacaine Adjuvants for Spinal Anaesthesia in Major Gynaecological Surgery","volume":"6","author":"Deepa","year":"2017","journal-title":"J Evol Med Dent Sci"},{"key":"R35-20250111","first-page":"1","article-title":"Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: A prospective, double blinded, randomized dose-response trial using the sequential allocation method","volume":"17","author":"Xiao","year":"2017","journal-title":"BMC Anesthesiol [Internet]"},{"key":"R36-20250111","doi-asserted-by":"crossref","first-page":"667","DOI":"10.4103\/ija.IJA_610_16","article-title":"Comparison of intrathecal clonidine and magnesium sulphate used as an adjuvant with hyperbaric bupivacaine in lower abdominal surgery","volume":"61","author":"Khandelwal","year":"2017","journal-title":"Indian J Anaesth"},{"key":"R37-20250111","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3344\/kjp.2017.30.3.207","article-title":"The impact of magnesium sulfate as adjuvant to intrathecal bupivacaine on intra-operative surgeon satisfaction and postoperative analgesia during laparoscopic gynecological surgery: Randomized clinical study","volume":"30","author":"Mohamed","year":"2017","journal-title":"Korean J Pain"},{"key":"R38-20250111","doi-asserted-by":"crossref","first-page":"471","DOI":"10.4103\/0019-5049.162982","article-title":"Comparison of different doses of magnesium sulphate and fentanyl as adjuvants to bupivacaine for infraumbilical surgeries under subarachnoid block","volume":"59","author":"Katiyar","year":"2015","journal-title":"Indian J Anaesth"},{"key":"R39-20250111","doi-asserted-by":"crossref","first-page":"0","DOI":"10.5812\/aapm.5(3)2015.22798","article-title":"Addition of intrathecal magnesium sulfate to bupivacaine for spinal anesthesia in cesarean section","volume":"5","author":"Banihashem","year":"2015","journal-title":"Anesthesiol Pain Med"},{"key":"R40-20250111","first-page":"1","article-title":"Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block","volume":"8","author":"Kathuria","year":"2014","journal-title":"J Clin Diagnostic Res"},{"key":"R41-20250111","first-page":"179","article-title":"The effect of adding magnesium sulphate to bupivacaine for spinal anaesthesia: A randomised, double- blind trial in patients undergoing lower limb orthopaedic surgery","volume":"5","author":"Jaiswal","year":"2013","journal-title":"Int J Pharm Pharm Sci"},{"key":"R42-20250111","doi-asserted-by":"crossref","first-page":"293","DOI":"10.4097\/kjae.2013.65.4.293","article-title":"Intrathecal injection of magnesium sulfate: Shivering prevention during cesarean section: A randomized, double-blinded, controlled study","volume":"65","author":"Faiz","year":"2013","journal-title":"Korean J Anesthesiol"},{"key":"R43-20250111","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.aat.2012.03.001","article-title":"Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery","volume":"50","author":"Khezri","year":"2012","journal-title":"Acta Anaesthesiol Taiwanica"},{"key":"R44-20250111","first-page":"24","article-title":"Augmented bupivacaine spinal anaesthesia in postoperative analgesia","volume":"2","author":"Okojie","year":"2012","journal-title":"J West Afr Coll Surg"},{"key":"R45-20250111","first-page":"918","article-title":"Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries","volume":"17","author":"Faiz","year":"2012","journal-title":"J Res Med Sci"},{"key":"R46-20250111","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1007\/s00540-011-1227-z","article-title":"Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: A randomized, double-blind trial in patients undergoing lower extremity surgery","volume":"25","author":"Khalili","year":"2011","journal-title":"J Anesth"},{"key":"R47-20250111","first-page":"570","article-title":"Efficacy and Safety of Intrathecal Magnesium Sulphate As an Adjunct To Bupivacaine for Lower Limb Orthopaeadic Surgery","volume":"2","author":"Paul","year":"2009","journal-title":"Pharmacologyonline"},{"key":"R48-20250111","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/j.1399-6576.2008.01864.x","article-title":"Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacaine 0.5% for parturients undergoing elective cesarean delivery","volume":"53","author":"Unlugenc","year":"2009","journal-title":"Acta Anaesthesiol Scand"},{"key":"R49-20250111","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/j.1399-6576.2007.01263.x","article-title":"Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: A prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery","volume":"51","author":"Arcioni","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"key":"R50-20250111","doi-asserted-by":"crossref","first-page":"159","DOI":"10.18203\/2319-2003.ijbcp20164773","article-title":"Comparison of intravenous Magnesium Sulphate with intrathecal Magnesium Sulphate for post- operative analgesia in orthopaedic patients undergoing extracapsular hip fracture surgery","volume":"6","author":"Kumar","year":"2016","journal-title":"Int J Basic Clin Pharmacol"},{"key":"R51-20250111","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s42077-022-00250-1","article-title":"Comparison of nalbuphine versus magnesium sulfate as an adjuvant to intrathecal hyperbaric bupivacaine (0.5%) in infraumbilical surgeries","volume":"14","author":"Kapdi","year":"2022","journal-title":"Ain-Shams J Anesthesiol"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_862_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:41:42Z","timestamp":1787773302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_862_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":49,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_862_24","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-08-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}