Inclusion Criteria:  Patients 18 years old or older. Patients with one or more acute traumatic rib fractures.  Exclusion Criteria:  Inability to position appropriately. Unconscious or heavily sedated. Patients who are critically ill such that care should not be delayed for regional anesthesia. Patients under the age of 18 years old. Vulnerable populations including prison inmates and pregnant patients. Overlying skin infection, wound, or dressing/equipment (i.e., Chest tube). Inability to visualize target anatomy or by ultrasound or anatomy prohibitive for other reasons to perform procedure successfully. Known or documented allergy to ropivacaine or other amide local anesthetic.