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{{Short description|Injection of substances into peritoneum (body cavity)}}
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{{Infobox interventions |
Name = Intraperitoneal injection |
synonyms = IP injection|
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ICD10 = |
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'''Intraperitoneal injection''' or '''IP injection''' is the injection of a substance into the [[peritoneum]] (body cavity). It is more often applied to non-human animals than to humans. In general, it is preferred when large amounts of blood replacement fluids are needed or when low blood pressure or other problems prevent the use of a suitable blood vessel for [[intravenous injection]].{{ref-needed|date=April 2015}}
In humans, the method is widely used to administer [[chemotherapy]] drugs to treat some [[cancer]]s, particularly [[ovarian cancer]]. Although controversial, intraperitoneal use in ovarian cancer has been recommended as a [[standard of care]].<ref name="pmid18006894">{{cite journal | vauthors = Swart AM, Burdett S, Ledermann J, Mook P, Parmar MK
Intraperitoneal injections are a way to administer therapeutics and drugs through a peritoneal route (body cavity). They are one of the few ways drugs can be administered through injection, and have uses in research involving animals, drug administration to treat ovarian cancers, and much more. Understanding when intraperitoneal injections can be utilized and in what applications is beneficial to advance current drug delivery methods and provide avenues for further research. The benefit of administering drugs intraperitoneally is the ability for the peritoneal cavity to absorb large amounts of a drug quickly. A disadvantage of using intraperitoneal injections is that they can have a large variability in effectiveness and misinjection.<ref name="Laferriere Pang">{{cite journal |
▲Intraperitoneal injections are a way to administer therapeutics and drugs through a peritoneal route (body cavity). They are one of the few ways drugs can be administered through injection, and have uses in research involving animals, drug administration to treat ovarian cancers, and much more. Understanding when intraperitoneal injections can be utilized and in what applications is beneficial to advance current drug delivery methods and provide avenues for further research. The benefit of administering drugs intraperitoneally is the ability for the peritoneal cavity to absorb large amounts of a drug quickly. A disadvantage of using intraperitoneal injections is that they can have a large variability in effectiveness and misinjection.<ref>{{cite journal |last1=Laferriere |first1=C.A. |last2=Pang |first2=D.S. |title=Review of intraperitoneal injection of sodium pentobarbital as a method of euthanasia in laboratory rodents |journal=Journal of the American Association for Laboratory Animal Science |date=2020 |volume=59 |issue=3 |pages=254–263 |doi=https://doi.org/10.30802/AALAS-JAALAS-19-000081}}</ref> Intraperitoneal injections can be similar to oral administration in that hepatic metabolism could occur in both.
==
There are few accounts of the use of intraperitoneal injections prior to 1970. One of the earliest recorded uses of IP injections involved the insemination of a guinea-pig in 1957.<ref>{{cite journal |
A good example of how intraperitoneal injections work is depicted through
These early uses of Intraperitoneal injections provide good examples of how the delivery method can be used, and provides a base for future studies on how to properly inject mice for research.
== Use in
Currently, there are a handful of drugs that are delivered through intraperitoneal injection for chemotherapy. They are mitomycin C, cisplatin, carboplatin, oxaliplatin, irinotecan, 5-
There are few examples of the use of intraperitoneal injections in humans cited in literature because it is mainly used to study the effects of drugs in mice. The few examples that do exist pertain to the treatment of pancreatic/ovarian cancers and injections of other drugs in clinical trials. Figure 1.0 roughly depicts where the injection would be administered to the peritoneal cavity in humans. One study utilized IP injections to study pain in the abdomen after a hysterectomy when administering anesthetic continuously vs patient-controlled.{{cite journal |last1=Perniola |first1=A |title=Postoperative pain after abdominal hysterectomy: a randomized, double-blind, controlled trial comparing continuous infusion vs patient-controlled intraperitoneal injection of local anaesthetic |journal=British Journal of Anaesthesia |date=2014 |volume=112 |issue=2 |pages=328–336 |doi=10.1093/bja/aet345.}}</ref> The results depicted that ketobemidone consumption was significantly lower when patients controlled anesthetic through IP. This led to the patients being able to be discharged earlier than when anesthesia was administered continuously. These findings could be advanced by studying how the route of injection affects the organs in the peritoneal cavity. ▼
▲[[File:Peritoneal Cavity Human1.jpg|thumb]]
▲There are few examples of the use of intraperitoneal injections in humans cited in literature because it is mainly used to study the effects of drugs in mice. The few examples that do exist pertain to the treatment of pancreatic/ovarian cancers and injections of other drugs in clinical trials
In another Phase I clinical trial, patients with ovarian cancer were injected intraperitoneally with dl1520 in order to study the effects of a replication-competent/-selective virus.{{cite journal |last1=Vasey |first1=P.A. |title=Phase I Trial of Intraperitoneal Injection of the E1B-55- kd-Gene–Deleted Adenovirus ONYX-015 (dl1520) Given on Days 1 Through 5 Every 3 Weeks in Patients With Recurrent/Refractory Epithelial Ovarian Cancer |date=2002 |page=8}}</ref> The effects of this study were the onset of flu-like symptoms, emesis, and abdominal pain. The study overall defines appropriate doses and toxicity levels of dl1520 when injected intraperitoneally.▼
▲In another Phase I clinical trial, patients with ovarian cancer were injected intraperitoneally with dl1520 in order to study the effects of a replication-competent/-selective virus.<ref>{{cite journal |
One study attempted to diagnose hepatic hydrothorax with the use of injecting Sonazoid intraperitoneally. Sonazoid was utilized to aid with contrast-enhanced ultrasonography by enhancing the peritoneal and pleural cavities.{{cite journal |last1=Tamano |first1=M. |title=Diagnosis of hepatic hydrothorax using contrast-enhanced ultrasonography with intraperitoneal injection of Sonazoid |journal=Journal of Gastroenterology and Hepatology |date=2010 |volume=25 |issue=2 |pages=383–386 |doi=10.1111/j.1440-1746.2009.06002.x}}</ref> This study demonstrates how intraperitoneal injections can be used to help diagnose diseases by providing direct access to the peritoneal cavity and affecting the organs in the cavity.▼
▲One study attempted to diagnose [[hepatic hydrothorax]] with the use of injecting Sonazoid intraperitoneally. Sonazoid was utilized to aid with contrast-enhanced ultrasonography by enhancing the peritoneal and pleural cavities.<ref>{{cite journal |
In a case of a ruptured hepatocellular carcinoma, it was reported that the patient was treated successfully through the use of an intraperitoneal injection of OK-432, which is an immunomodulatory agent.{{cite journal |last1=Shiratori |first1=M. |title=Successful treatment of ruptured hepatocellular carcinoma with intraperitoneal injection of OK-432 |journal=Journal of Hepato-Biliary-Pancreatic Surgery |date=2004 |volume=11 |issue=6 |pages=426–429 |doi=10.1007/s00534-004-0921-8}}</ref> The patient was a 51 year old male who was hospitalized. The delivery of OK-432 occurred a total of four times in a span of one week. The results of this IP injection were the disappearance of the ascites associated with the rupture. This case is a good example of how IP injections can be used to deliver a drug that can help to treat or cure a medical diagnosis over the use of other routes of delivery. The results set a precedent of how other drugs may be delivered in this way to treat other similar medical issues after further research.▼
▲In a case of a ruptured hepatocellular carcinoma, it was reported that the patient was treated successfully through the use of an intraperitoneal injection of OK-432, which is an immunomodulatory agent.<ref>{{cite journal |
In 2018, a patient with stage IV ovarian cancer and peritoneal metastases was injected intraperitoneally with 12g of mixed cannabinoid before later being hospitalized.{{cite journal |last1=Lucas |first1=C.J. |last2=Galettis |first2=P. |last3=Song |first3=S. |last4=Solowij |first4=N. |last5=Reuter |first5=S.E. |last6=Schneider |first6=J. |last7=Martin |first7=J.H. |title=Cannabinoid Disposition After Human Intraperitoneal Use: An Insight Into Intraperitoneal Pharmacokinetic Properties in Metastatic Cancer |journal=Clinical therapeutics |date=2018 |volume=40 |issue=9 |pages=1442–1447}}</ref> The symptoms of this included impairment of cognitive and psychomotor abilities. Because of the injection of cannabis, the patient was predicted to have some level of THC in the blood from absorption. This case presents the question of how THC is absorbed in the peritoneal cavity. It also shows how easily substances are absorbed through the peritoneal cavity after an IP injection.▼
▲In 2018, a patient with stage IV ovarian cancer and peritoneal metastases was injected intraperitoneally with 12g of mixed cannabinoid before later being hospitalized.<ref>{{cite journal |
Overall, this section provides a few examples of the effects and uses of intraperitoneal injections in human patients. There are a variety of uses and possibilities for many more in the future with further research and approval.
== Use in
There has been some debate on whether intraperitoneal injections are the best route of administration for experimental animal studies. It was concluded in a review article that utilizing IP injections to administer drugs to laboratory rodents in experimental studies is acceptable when being applied to proof-of-concept studies.<ref>{{cite journal |
A study was conducted to determine the best route of administration to transplant mesenchymal stem cells for colitis. This study compared intraperitoneal injections, intravenous injections, and anal injections. It was concluded that the intraperitoneal injection had the highest survival rate of 87.5%.<ref>{{cite journal |
One article reviews the injection of sodium pentobarbital to euthanize rodents intraperitoneally.
Another example of how intraperitoneal injections are used in studies involving rodents is the use of IP for micro-CT contrast enhanced detection of liver tumors.<ref>{{cite journal |
An example of how intraperitoneal injections can be optimized is depicted in a study where IP injections are used to deliver anesthesia to mice. This study goes over the dosages, adverse effects, and more of using intraperitoneal injections of anesthesia.<ref>{{cite journal |
An example of when intraperitoneal injections are not ideal is given in a study where the best route of administration was determined for cancer biotherapy.<ref>{{cite journal |
The provided examples show a variety of uses for intraperitoneal injections in animals for in vitro studies. Some of the examples depict situations where IP injections are not ideal, while others prove the advantageous uses if this delivery method. Overall, many studies utilize IP injections to deliver therapeutics to lab animals due to the efficiency of the administration route.
== References ==▼
▲Currently, there are a handful of drugs that are delivered through intraperitoneal injection for chemotherapy. They are mitomycin C, cisplatin, carboplatin, oxaliplatin, irinotecan, 5-fluoruracil, gemcitabine, paclitaxel, docetaxel, doxorubicin, premetrexed, and melphalan.{{cite journal |last1=Bree |first1=Eelco de |last2=Michelakis |first2=Dimosthenis |last3=Stamatiou |first3=Dimitris |last4=Romanos |first4=John |last5=Zoras |first5=Odysseas |title=Pharmacological principles of intraperitoneal and bidirectional chemotherapy |journal=Pleura and Peritoneum |date=1 June 2017 |volume=2 |issue=2 |pages=47–62 |doi=https://doi.org/10.1515/pp-2017-0010}}</ref> There needs to be more research done to determine appropriate dosing and combinations of these drugs to advance intraperitoneal drug delivery.
▲==References==
{{reflist}}
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