The basis for our proposal stems from a recent study by J Van Der Westhuizen, et al. They set out to determine if the traditional one gram unit dose reached adequate serum concentrations of greater than 10 mcg/ml. They compared 1 gram each of intravenous (IV) and oral acetaminophen to see if one or both achieved therapeutic plasma concentrations peri-operatively and for how long. This study questioned the use of oral acetaminophen at 1 gram because if it was not achieving therapeutic concentrations, the patients were not getting optimal care (5). From this study, they were able to extrapolate oral doses of 20 mg/kg that would achieve a maximum concentration of 19 mcg/ml (which is the median maximum concentration achieved by IV acetaminophen). The study concluded that for subjects over 75 kg, an effective IV equivalent oral acetaminophen dose would be 1.5 grams or even 2 grams if the subject exceeded 100 kg (5). This study further recommended a follow up study to evaluate these higher doses of oral acetaminophen as it relates to pain scores and rescue medications postoperatively compared to the IV dose of 1 gram. The current unit dose of oral acetaminophen is 1 gram every 6 hours. However, many studies have evaluated the effects of higher doses of oral acetaminophen as well (10, 11). One study supported the use of 5-6 grams of acetaminophen in a 24- hour period in order to reduce requirements for postoperative morphine. requirements (6). Another study measured serum and CSF concentrations one hour after administration of 500 mg, 1 gm, 1.5 gm, or 2 gm of oral acetaminophen (7).