Background: Multiple rib fractures are commonly associated with severe pain, impaired respiratory function, and increased risk of pulmonary complications. Effective analgesia is essential to improve patient outcomes. Ultrasound-guided regional techniques such as thoracic erector spinae plane block (ESPB) and paravertebral block (PVB) are increasingly used, but comparative evidence remains limited.

Methods: This prospective randomized controlled trial was conducted in 100 patients with multiple rib fractures between June 2024 and June 2026. Patients were randomly allocated into two groups: ESPB group (n=50) and PVB group (n=50). Hemodynamic parameters, Visual Analog Scale (VAS) pain scores, fentanyl consumption, and time to rescue analgesia were assessed at predefined intervals up to 48 hours.

Results: Baseline characteristics were comparable between the groups. There was no statistically significant difference in heart rate, mean arterial pressure, or VAS pain scores at rest and during movement at any time interval (p>0.05). However, fentanyl consumption was significantly lower in the ESPB group (134.9±35.8 µg) compared to the PVB group (176.87±27.5 µg) (p=0.0001). Additionally, time to rescue analgesia was significantly prolonged in the ESPB group (154 minutes) compared to the PVB group (74 minutes) (p=0.027).

Conclusion: Ultrasound-guided ESPB provides analgesia comparable to PVB with reduced opioid requirement and longer duration of action, making it a favorable option in managing pain due to multiple rib fractures.

KEYWORDS: Erector Spinae Plane Block, Paravertebral Block, Rib Fractures, Analgesia, Ultrasound-Guided Block, Randomized Controlled Trial.