Inclusion Criteria:  Age >=18 At least 1 acute rib fracture. Acute defined as within 7 days of presentation. Numerical pain score on presentation at least 5 out of 10. This will identify patients that justify the invasive procedure. Admitted to hospital for at least 24 hours of observation. Be able to consent and participate in study by assuming necessary positioning for intervention  Exclusion Criteria:  Hypotension/shock (shock index >1.0, SBP < 90) Distracting injury not amenable to ESPB as determined by the enrolling physician. (i.e extremity fracture, burn, laceration, contusion, joint dislocation, etc.) Examples of patients not able to consent/participate are intubated patients or patients in spinal precautions (i.e c-collar) Known hypersensitivity to local anesthetic Evidence of infection at the proposed site of injection